Results from the large, four-year study of 560 patients newly diagnosed with malignant gliomas support the finding that resection is a strong factor in prognosis for survival. Gliomas are cancerous tumors that originate in glial cells, the supporting tissue for the brain's neurons. A patients' age, the grade of the tumor, which measures degree of malignancy, and the patients' overall physical health and activity level are also important factors for survival with good quality of life.
The observational study, called the Glioma Outcomes project, examined the overall clinical management of patients with malignant gliomas and the patients' satisfaction through their course of treatment. The study was led by physicians at the Department of Neurological Surgery at U.Va. Fifty-two clinical sites in North America participated, from academic medical centers to private practices. The results are published in the September issue of the Journal of Neurosurgery.
"The major advantage of this study is that it provides a contemporary benchmark analysis of patterns of care and outcomes for patients with malignant gliomas," said Dr. Edward R. Laws, Jr., professor of neurological surgery at U.Va. and the primary investigator for the project. "Survival data from this study can be helpful when considering the diagnosis and management of patients with brain tumors. However, it is important to note that aggressive resection of gliomas will not necessarily improve the prognosis for a specific patient. Some patients may have been precluded from a craniotomy, for instance, because they could not tolerate a general anesthetic," Laws said. "Age and general health are also key variables in survivability, with younger, more active patients more able to benefit from glioma treatment."
The patients who were part of the project had either Grade III gliomas or more severe Grade IV glioblastomas. Over half of the Grade III patients (58 percent) were alive and well two years after diagnosis. But just 11 percent of Grade IV glioblastoma did well during the same period after diagnosis.
Early detection and treatment of gliomas is critical for survivability, Laws said. For example, in patients between 20 and 40 years of age, median survival was good (87.9 weeks for Grade III gliomas and 70.9 weeks for Grade IV glioblastomas). For patients over 60, median survival dropped to 43.2 weeks for patients with a Grade III glioma and 39.1 weeks for those with a Grade IV tumor.
Patients who underwent craniotomy and resection also fared better than those who had biopsy only. For patients with a Grade III tumor, the median survival was 87 weeks after resection but just 52.1 weeks after biopsy. Grade IV glioblastoma patients survived 45.3 weeks after resection. The median survival for Grade IV patients after biopsy was 21 weeks.
In addition to U.Va.'s Department of Neurological Surgery, participating institutions in the study were the University of California San Francisco, the University of Massachusetts, the Carolina Neuroscience Institute, the University of Colorado, the University of Toronto, Johns Hopkins University and Wayne State University.
Journal
Journal of Neurosurgery