Wong et al evaluated outcomes in patients with high grade cerebral gliomas. These can help identify patients who may require more aggressive management and closer monitoring. The authors are from M.D. Anderson Cancer Center and the University of California at San Francisco.
Patient selection:
(1) high grade glioma (anaplastic astrocytoma or glioblastoma multiforme)
(2) age > 16 years
(3) enrollment Karnofsky Performance Scale > 50
Prognostic factors:
(1) histologic type
(2) Karnofsky performance scale (KPS)
(3) salvage surgery
Prognostic Factor |
Finding |
Points |
histologic type |
anaplastic astrocytoma |
0 |
|
glioblastoma multiforme |
1 |
Karnofsky Performance Scale |
>= 80 |
0 |
|
< 80 |
1 |
salvage surgery |
no |
0 |
|
yes |
1 |
where:
• According to Table 3, page 2576, the Karnofsky Performance Scale was protective. A higher KPS would be a surrogate marker for overall tumor burden and/or adverse reactions to therapy.
total number of adverse prognostic factors =
= SUM(points for all 3 prognostic factors)
Interpretation:
• minimum number of adverse prognostic factors: 0
• maximum number of adverse prognostic factors: 3
• The greater the number of adverse prognostic factors the worse the outcome.
• Median progression free survival for anaplastic astrocytoma was 12 weeks and for glioblastoma was 9 weeks. Progression free survival at 2 years for anaplastic astrocytoma was around 10% and for glioblastoma was less than 5% (from Figure 2).
• Median overall survival for all of the patients was 26 weeks, with 1 year survival of 32% and 5 year of 10%.
Specialty: Hematology Oncology, Surgery, general, Neurology