title: Gliomatosis cerebri having a poor performance status without recurrence after radiotherapy: a single institutional experience.
abstract: OBJECTIVE
  Radiotherapy (RT) has been advocated for gliomatosis cerebri (GC) to delay tumor progression. However, patients with GC may experience poor performance status without recurrence after RT. Herein, we reviewed the responses of patients with GC treated with RT.
  
  
  METHODS
  Seventeen patients with diffuse radiologic infiltration of more than two cerebral lobes and diagnosed as having grade II (N=12) or III (N=5) glioma were treated with a mean radiation dose of 51.8 Gy (range, 42-59.4 Gy). The mean radiation volume to a mean marginal dose of 42.8 Gy (range, 36-45 Gy) was 693.4 cc (range, 316.5-1279.6 cc), which was 45.3% of the mean whole brain volume. We reviewed the clinical prognostic factors related to progression-free survival (PFS) and overall survival (OS) in all patients and described characteristics of patients with poor performance (Eastern Cooperative Oncology Group performance scale 3-4) without recurrence.
  
  
  RESULTS
  In all patients, the median PFS was 12.3 months, and oligodendroglial pathology (p=0.002) and non-enhanced tumor (p=0.002) were associated with an improved PFS. The median OS was 39.3 months, and young age and adjuvant chemotherapy were associated with improved OS (p=0.022 and 0.002, respectively). Based on multivariate analysis, adjuvant chemotherapy was significantly associated with a longer OS (p=0.012; hazard ratio=0.099; 95% CI, 0.016-0.596). Five patients (29.4%) showed poor performance without recurrence. The median age of these 5 patients was 65 years (range, 60-75 years). The mean radiation volume to a mean marginal dose of 41 Gy (range, 36-45 Gy) was 539.9 cc (range, 255.5-983.1 cc). The pathologic diagnosis was grade II glioma in 2 patients and grade III in 3 patients. The median OS was 10.0 months (range, 8.2-45.9 months).
  
  
  CONCLUSIONS
  Some GC patients, especially the elderly, might have a poor performance status without recurrence after RT of a larger radiation field.
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea. Electronic address: jung-ty@chonnam.ac.kr.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Mee-Sun
authors.initials: MS
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Young-Hee
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: In-Young
authors.initials: IY
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Woo-Youl
authors.initials: WY
authors.lastname: Jang
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Kyung-Sub
authors.initials: KS
authors.lastname: Moon
authors.affiliation: Department of Pathology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Seul-Kee
authors.initials: SK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D018302:Neoplasms, Neuroepithelial / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating
keywords: Chemotherapy; Elderly; Gliomatosis cerebri; Performance; Radiotherapy