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Indicators of Functional Status for Primary Malignant Brain Tumour Patients

Published online by Cambridge University Press:  02 December 2014

Miguel Bussière ,
Wilma Hopman ,
Andrew Day ,
Alicia Paris Pombo ,
Teresa Neves  and
Francisco Espinosa
Miguel Bussière
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, ON, Canada
Wilma Hopman
Affiliation:
Clinical Research Centre, Queen’s University, Kingston, ON, Canada Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada
Andrew Day
Affiliation:
Clinical Research Centre, Queen’s University, Kingston, ON, Canada
Alicia Paris Pombo
Affiliation:
Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada
Teresa Neves
Affiliation:
Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada
Francisco Espinosa
Affiliation:
Division of Neurosurgery, Department of Surgery, Queen’s University, Kingston, ON, Canada
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Abstract

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Background:

We compared the functional status and survival time of patients with malignant gliomas.

Methods:

This retrospective review included 143 patients diagnosed with malignant gliomas. Patients were grouped according to histopathological diagnosis. To measure functional status, patients were assigned a Karnofksy performance status (KPS) score at the time of presentation and at one, three, six, nine, 12 months and yearly intervals thereafter. Data were analyzed using descriptive methods as well as Kruskal-Wallis tests, Chi-square tests, Log-Rank tests and Cox’s proportional hazards modeling.

Results:

Eighty-four patients were male. The median age of patients was 63 years. One hundred and seven patients had a histopathological diagnosis of glioblastoma multiforme, 23 of anaplastic astrocytoma and 13 of anaplastic oligodendroglioma. Twenty-nine patients received aggressive multimodal treatment, 83 received intermediate treatment and the remaining 31 patients received conservative therapy. Significant treatment complications occurred in 33% of patients including four post-operative deaths. The anaplastic oligodendroglioma group had lower mortality and maintained better KPS scores over time, as did patients receiving full treatment. The most significant prognostic factors for functional status included age, pretreatment KPS, and type of treatment received. The most significant factors associated with time until death included age, severity of comorbidities, pretreatment KPS, presence of confusion, histopathological diagnosis and type of treatment received.

Conclusion:

In patients with malignant gliomas, younger age, better functional status at presentation and aggressive multimodal treatment were associated with improved longer-term functional status and survival. Confirmation of the effect of multimodal treatment on patient functional status would require a randomised controlled clinical trial.

Résumé:

RÉSUMÉ:Introduction:

Nous avons compare l’état fonctionnel et la survie de patients atteints de gliomes malins

Méthodes:

Cette revue rétrospective porte sur 143 patients porteurs d’un gliome malin. Ils ont été classés selon le diagnostic anatomopathologique. Un score était attribué à chaque patient selon l’indice fonctionnel de Karnofksy (IFK) à la consultation initiale et après 1, 3, 6, 9 et 12 mois de suivi et de façon annuelle par la suite. Les données ont été analysées au moyen de méthodes descriptives ainsi que du test de Kruskal–Wallis, du test du chi–carré, du test du log–rank et du modèle à hasard proportionnel de Cox.

Résultats:

Quatrevingt– quatre patients étaient des hommes et l’âge médian des patients était de 63 ans. Selon l’examen anatomopathologique, cent sept patients avaient un glioblastome multiforme, alors que chez 23 la tumeur était un astrocytome anaplasique et chez 13 un oligodendrogliome anaplasique. Vingt–neuf patients ont reçu une polythérapie agressive, 83 ont reçu un traitement intermédiaire et les 31 autres patients ont reçu un traitement conservateur. 33% des patients ont eu des complications importantes dues au traitement, dont quatre décès en période post–opératoire. Le groupe de patients atteints d’un oligodendrogliome an aplasique, de même que les patients ayant reçu un traitement agressif, avaient une mortalité plus basse et ont maintenu de meilleurs scores IFK pendant la période d’observation. Les facteurs qui prédisaient le mieux l’état fonctionnel étaient l’âge, l’IFK avant le traitement et le type de traitement reçu. Les facteurs les plus importants associés à la survie étaient l’âge, la sévérité des cormobidités, l’IFK avant traitement, le présence de confusion, le diagnostic anatomopathologique et le type de traitement reçu.

Conclusion:

Chez les patients atteints de gliomes malins, on observe un meilleur état fonctionnel et une survie plus longue chez ceux qui sont plus jeunes, qui ont un meilleur état fonctionnel au moment du diagnostic et qui reçoivent un traitement multimodal agressif. L’effet d’un traitement multimodal sur l’état fonctionnel des patients devra être confirmé par un essai clinique contrôlé randomisé.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 50 - 56
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1 Gaudette, LA, Lee, J. Statistics Canada. Cancer Incidence in Canada, 1969-1993. Ottawa: Health Statistics Division, Catalogue 82-566-XPB. Occasional, Ottawa, April 1997.Google Scholar
2 Chen, VW, Howe, HL, Wu, XC, Hotes, JL, Correa CN (Eds). Cancerin North America, 1993-1997. Volume One: Incidence, Volume Two: Mortality. Sacramento, CA: North American Association of Central Cancer Registries, April 2000.Google Scholar
3 Desmeules, M, Mikkelson, T, Mao, Y. Increasing incidence of primarymalignant brain tumours: Influence of diagnostic methods. J Natl Cancer Inst 1992; 84: 442–445.CrossRefGoogle Scholar
4 Riggs, JE. Rising primary malignant brain tumor mortality in theelderly. Arch Neurol 1995; 52: 571–575.CrossRefGoogle Scholar
5 Fernandez, PM, Brem, S. Malignant brain tumours in the elderly. Clin Geriatr Med 1997; 13: 327–338.CrossRefGoogle ScholarPubMed
6 Fine, HA. The basis for current treatment recommendations formalignant gliomas. J Neurooncol 1994; 20: 111–120.CrossRefGoogle Scholar
7 Forsyth, PAJ, Cairncross, JG. Treatment of malignant glioma inadults. Curr Opin Neurol 1995; 8: 414–418.CrossRefGoogle Scholar
8 Whittle, IR. Management of primary malignant brain tumours. J Neurol Neurosurg Psychiatry 1996; 60: 2–5.CrossRefGoogle ScholarPubMed
9 Chamberlain, MC, Kormanik, PA. Practical guidelines for thetreatment of malignant gliomas. West J Med 1998; 168: 114–200.Google Scholar
10 Levin, VA. Neuro-oncology. an overview. Arch Neurol 1999;56:401–403.CrossRefGoogle ScholarPubMed
11 Whittle, IR, Denholm, SW, Gregor, A. Management of patients agedover 60 years with supratentorial glioma: lessons from an audit. Surg Neurol 1991; 36: 106–111.CrossRefGoogle Scholar
12 Halperin, EC. Malignant gliomas in older adults with poorprognostic signs. Getting nowhere, and taking a long time to doit. Oncology 1995; 9: 229–234.Google Scholar
13 Curran, WJ, Scott, SB, Horton, J, et al. Recursive partitioning analysisof prognostic factors in three radiation therapy oncology group malignant glioma trials. J Natl Cancer Inst 1993; 85: 704–710.CrossRefGoogle Scholar
14 Mohan, DS, Suh, JH, Phan, JL, et al. Outcome in elderly patientsu n d e rgoing definitive surgery and radiation therapy for supratentorial glioblastoma multiforme at a tertiary care institution. Int J Radiat Oncol Biol Phys 1998; 42: 981–987.CrossRefGoogle Scholar
15 Medical Research Council Brain Tumour Working Party. Prognosticfactors for high-grade malignant glioma: development of a prognostic index. J Neurooncol 1990; 9: 47–55.CrossRefGoogle Scholar
16 Shapiro, WR, Young, DF. Chemotherapy of malignant glioma. Acontrolled study of chemotherapy and irradiation. Arch Neurol 1976; 33: 494–500.CrossRefGoogle Scholar
17 Hochberg, FH, Linggood, R, Wolfson, L, Baker, WH, Kornblith, P. Quality and duration of survival in glioblastoma multiforme. Combined surgical, radiation, and lomustine therapy. JAMA 1979; 241: 1016–1018.CrossRefGoogle ScholarPubMed
18 Shapiro, WR. Treatment of neuroectodermal brain tumours. Ann Neurol 1982; 12: 231–237.CrossRefGoogle Scholar
19 Ammimrati, M, Vick, N, Liao, Y, Ciric, I, Mikhael, M. Effect of theextent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 1987; 21: 201–206.CrossRefGoogle Scholar
20 Leibel, SA, Gutin, PH, Wara, WM, et al. Survival and quality of lifeafter interstitial implantation of removable high activity Iodine-125 sources for the treatment of patients with recurrent malignant gliomas. Int J Radiat Oncol Biol Phys 1989; 17: 1129–1139.CrossRefGoogle Scholar
21 Sachsenheimer, W, Piotrowski, W, Bimmler, T. Quality of life inpatients with intracranial tumours on the basis of Karnofsky’s performance status. J Neurooncol 1992; 13: 177–181.CrossRefGoogle Scholar
22 Choksey, MS, Valentine, A, Shawdon, H. Computed tomography inthe diagnosis of malignant brain tumours: do all patients require biopsy? J Neurol Neurosurg Psychiatry 1989; 52: 821–825.CrossRefGoogle Scholar
23 Karnofsky, DA. The clinical evaluation of chemotherapeutic agentsin cancer. In: Macleod, CM, Burchenal, JH (Eds). Evaluation of Chemotherapeutic Agents. New York: Columbia Univ. Press. 1949:191–205.Google Scholar
24 Coscarelli Shag, C, Heinrich, RL, Ganz, PA. Karnofsky performancestatus revisited: reliability, validity and guidelines. J Clin Oncol 1984; 2: 187–193.Google Scholar
25 Mor, V, Laliberte, L, Morris, JN, Wiemann, M. The Karnofsky statusscale: an examination of its reliability and validity in a researchsetting. Cancer 1984; 53: 2002-2007.3.0.CO;2-W>CrossRefGoogle Scholar
26 Barker, FG, Prados, MD, Chang, SM, et al. Radiation response andsurvival time in patients with glioblastoma multiforme. J Neurosurg 1996; 84: 442–448.CrossRefGoogle Scholar
27 Fine, HA, Dear, KBG, Loeffler, JS, Black, PM, Canellos, GP. Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 1993; 71: 2585–2597.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
28 Hildebrand, J, Sahmoud, T, Mignolet, F, Brucher, JM, Afra, D, EORTC Brain Tumour Group. Adjuvant therapy with dibromodulcitol and BCNU increases survival of adults with malignant gliomas. Neurology 1994; 44: 1479–1483.CrossRefGoogle ScholarPubMed
29 DeAngelis, LM, Burger, PC, Green, SB, Cairncross, JG. Malignantglioma: who benefits from adjuvant chemotherapy? Ann Neurol 1998; 44: 691–695.CrossRefGoogle Scholar
30 Cairncross, JG, MacDonald, DR. Successful chemotherapy forrecurrent malignant oligodendrogliomas. Ann Neurol 1988; 23: 360–364.CrossRefGoogle Scholar
31 MacDonald, DR, Gasper, LE, Cairncross, JG. Successfulchemotherapy for newly diagnosed aggressive oligodendro-glioma. Ann Neurol 1990; 27: 573–574.CrossRefGoogle Scholar
32 Cairncross, JG, MacDonald, DR, Ludwin, S, et al. Chemotherapy foranaplastic oligodendroglioma J Clin Oncol 1994; 12: 2013–2021.CrossRefGoogle ScholarPubMed
33 Yung, WKA, Prados, MD, Yaya-Tur, R, et al. Multicenter phase IItrial of temozolamide in patients with anaplastic astrocytoma or anaplastic oligodendroglioma at first relapse. J Clin Oncol 1999; 17: 2762–2771.CrossRefGoogle Scholar
34 Yung, WKA, Albright, RE, Olson, J, et al. A phase II study oftemozolamide vs. probarbazine in patients with glioblastomamultiforme at first relapse. Br J Cancer 2000; 83: 588–593.CrossRefGoogle Scholar
35 Stupp, R, Dietrich, P, Kraljevic, SO, et al. Promising survival forpatients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 2002; 20: 1375–1382.CrossRefGoogle Scholar
36 Mackworth, N, Fobair, P, Prados, MD. Quality of life self-reportsfrom 200 brain tumor patients: comparisons with Karnofsky performance scores. J Neurooncol 1992; 14: 243–253.Google ScholarPubMed
37 Weitzner, MA, Meyers, CA. Cognitive functioning and quality of lifein malignant glioma patients: a review of the literature. Psychooncology 1997; 6: 167–177.3.0.CO;2-#>CrossRefGoogle Scholar
38 Aiken, RD. Quality of life in patients with malignant gliomas. SeminOncol 1994; 21: 273–275.Google ScholarPubMed