title: Malignant cerebral glioma--I: Survival, disability, and morbidity after radiotherapy.
abstract: 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.
authors.affiliation: St Bartholomew's Hospital, London.
authors.forename: E
authors.initials: E
authors.lastname: Davies
authors.forename: C
authors.initials: C
authors.lastname: Clarke
authors.forename: A
authors.initials: A
authors.lastname: Hopkins
mesh_terms: 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