title: Clinical course of high-grade glioma patients with a "biopsy-only" surgical approach: a need for individualised treatment.
abstract: BACKGROUND
  'Biopsy-only' high-grade glioma (HGG) patients get limited benefit from post-operative treatments, and as a group, negatively impact median survival outcomes.
  
  
  METHODS
  We retrospectively evaluated clinical characteristics, treatment and overall survival of HGG patients with a 'biopsy- only' surgical approach diagnosed between 1997 and 2005 at a University Hospital in Spain.
  
  
  RESULTS
  In 31% of 294 suspected gliomas, only a diagnostic biopsy was undertaken. Reasons for 'biopsy-only' for all patients were either location in eloquent areas: (motor area 18.7%, language area 25,3%, basal ganglia 7.7%, visual area 4.4%) or extension of the disease (corpus callosum invasion 14.3% and multicentricity/multifocality 28.6%). Seventy-four patients (80.4%) were HGG: 26% of all grade IV and 49% of all grade III tumours. For these patients, post-operative Karnofsky Performance Status of over 70%, median age and median survival were, respectively: 64 and 70%, 60.7 and 57 years old, and 23.1 and 42.7 weeks (p=0.0006). Patients lived longer if post-operative treatment was given, in all grades (p<0.0001). Nineteen patients (25.6%) died within 42 days after surgery. Only 60% of them initiated radiotherapy and 10% of them did not complete it. However, tumour grade, radiotherapy and temozolomide- based chemotherapy were independently associated with longer survival in multivariate analysis (p<0.05).
  
  
  CONCLUSIONS
  Almost one third of HGG patients can undergo only a biopsy and not debulking surgery. Although radiotherapy improves survival, only 50% of them complete the treatment. An individualised approach to these patients is needed to facilitate a correct analysis of therapy results. New therapies must be investigated in these patients.
authors.affiliation: Medical Oncology Service, Institut Català d'Oncologia, Germans Trias i Pujol, Badalona, Barcelona, Spain. cbalana@iconcologia.net
authors.forename: C
authors.initials: C
authors.lastname: Balaña
authors.forename: J
authors.initials: J
authors.lastname: Capellades
authors.forename: P
authors.initials: P
authors.lastname: Teixidor
authors.forename: I
authors.initials: I
authors.lastname: Roussos
authors.forename: R
authors.initials: R
authors.lastname: Ballester
authors.forename: M
authors.initials: M
authors.lastname: Cuello
authors.forename: A
authors.initials: A
authors.lastname: Arellano
authors.forename: R
authors.initials: R
authors.lastname: Florensa
authors.forename: R
authors.initials: R
authors.lastname: Rosell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005910:Glioma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate