Malignant cerebral glioma--I: Survival, disability, and morbidity after radiotherapy.
OBJECTIVE
To describe survival, disability, and morbidity after radiotherapy for malignant glioma.


METHODS
Two year prospective study with home interviews with patients and relatives.


METHODS
Seven neurosurgical and radiotherapy centres in London.


METHODS
105 patients aged 21 to 75: 59 had biopsy; 46 had partial macroscopic resection; 92 received radiotherapy; and 13 received steroids alone.


METHODS
Survival, time free from disability, and changes in disability after treatment.


RESULTS
Six and 12 month survival for radiotherapy patients was 70% and 39%, respectively. Age, World Health Organisation clinical performance status, extent of surgery, and history of seizures before diagnosis each influenced survival. The Medical Research Council prognostic index was also significantly related to survival. Multivariate analysis showed that initial clinical performance status was the most important component of the index. Most (80%; 49/61) patients with a clinical performance status of 0, 1, or 2 lived at least six months before becoming permanently disabled. Most patients who had initially had a good clinical performance status (0-2) and who were alive six months after radiotherapy (68%; 36/52), however, had experienced either clinical deterioration or severe tiredness after treatment. In 17% (9/52) of these some permanent loss of function remained. These adverse effects were associated with increasing radiotherapy dose. Severely disabled patients (clinical performance status 3 or 4) gained little benefit.


CONCLUSIONS
Severely disabled patients gain little physical benefit from radiotherapy, whereas those not so disabled may experience considerable adverse effects.
Davies
E
E
St Bartholomew's Hospital, London.
Clarke
C
C
Hopkins
A
A
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy*; D017281:Cost of Illness; D006233:Persons with Disabilities; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005910:Glioma / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D016019:Survival Analysis; D015996:Survival Rate