title: A prospective study of surgical patterns of care for high grade glioma in the current era of multimodality therapy.
abstract: Previous surgical patterns of care reports in high grade glioma (HGG) antedated the use of chemo-radiotherapy. This study, from an elective neurosurgical centre serving an isolated population of over 2 million, identified adult patients with HGG from a prospective multidisciplinary database. Of 328 patients in Western Australia who were diagnosed with HGG between 1 June 2006 and 30 June 2008, 283 patients (86%) received care at the study site. A total of 4% were diagnosed on imaging and clinical factors alone; 12% had surgery outside the study site. The remaining 231 patients had 264 surgical procedures; 78% resection and 22% biopsy. Median survival (grade IV) was 9.4 months. Resection predicted improved survival (hazard ratio 0.64; 95% confidence interval 0.4-0.89); however, in multivariable analysis, only age and grade predicted outcome. The proportion of patients having no tissue diagnosis, or biopsy alone, compares favourably with data before the use of chemo-radiotherapy, as does survival. The therapeutic nihilism surrounding HGG may have decreased since the introduction of temozolomide.
authors.affiliation: Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. anowak@meddent.uwa.edu.au
authors.forename: A K
authors.initials: AK
authors.lastname: Nowak
authors.forename: J E
authors.initials: JE
authors.lastname: Maujean
authors.forename: M
authors.initials: M
authors.lastname: Jackson
authors.forename: N
authors.initials: N
authors.lastname: Knuckey
mesh_terms: D000367:Age Factors; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods* / Q000401:mortality; D005260:Female; D005910:Glioma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D015996:Survival Rate