Prognosis of gliomas in the 1970s and today.
The benefit of the current strategy for diagnosis (magnetic resonance, [MR] imaging) and treatment (surgery, chemotherapy, radiotherapy) of gliomas, in contrast to the standard treatment in use before MR imaging and the microsurgical era, has not yet been determined. A retrospective statistical analysis was performed for all patients with glioma who underwent surgery at a single institution between 1965 and 1974 (Group I, 88 patients) or 1986 and 1995 (Group II, 249 patients). There were no major differences in symptomatology, tumor localization, and number of surgical procedures. The mean time until tumor diagnosis was significantly shorter in Group II (Group I, 48 weeks; Group II, 19.5 weeks). Also, the mean time from initial symptoms to surgery was significantly shorter for high-grade gliomas in Group II (Group I, 16.3 weeks; Group II, 11.7 weeks). For high- as well as low-grade gliomas, there was a clear reduction of the perioperative morbidity and mortality rates in Group II. Nevertheless, for the postoperative duration of survival, no significant differences were demonstrated for high- or low-grade gliomas. Based on the results of this study, the perioperative morbidity and mortality rate as well as the time from diagnosis to treatment have been remarkably reduced within the last 30 years. Nevertheless, the overall prognosis for patients with gliomas has not changed from the 1970s until today. Thus, the introduction of modern diagnostic modalities and surgical procedures has not improved the outcome in patients with glioma. Further research to improve the treatment of this disease is urgently needed.
Oertel
Joachim
J
Department of Neurosurgery, Hannover Nordstadt Hospital, Hannover, Germany. oertelj@freenet.de
von Buttlar
Ekaterina
E
Schroeder
Henry Werner Siegfried
HW
Gaab
Michael Robert
MR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000266:history / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000639:trends; D042241:Early Diagnosis; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D049673:History, 20th Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000266:history / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000517:prevention & control; D011379:Prognosis; D011788:Quality of Life; D011878:Radiotherapy / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome