Supratentorial low-grade glioma in adults: An analysis of prognostic factors and timing of radiation
Supratentorial low-grade glioma in adults: An analysis of prognostic factors and timing of radiation
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DOI：
10.1200/jco.1997.15.4.1294
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发表时间：
1997-04-01
影响因子：
45.3
通讯作者：
Cairncross, G
中科院分区：
文献类型：
--
作者：
Leighton, C;Fisher, B;Cairncross, G
用途：29回顾了通过现代影像学诊断的低级别胶质瘤患者的结局，这些患者在一个通常采用延迟放疗的中心接受治疗。我们查阅了（年龄大于或等于18岁），病理证实幕上低级别星形细胞瘤，少突胶质细胞瘤，1979年至1995年间，在加拿大的一个地区癌症中心治疗了10例神经胶质瘤和10例混合性神经胶质瘤。（N = 167;平均年龄40.6岁）为10.5年，5年和10年生存率分别为72%和50%。中位无进展生存期为4.9年，5年和10年无进展率分别为50%和12%。少突胶质细胞瘤或混合型胶质细胞瘤患者的总体和无进展生存期长于星形细胞瘤患者（中位数13 v7.5年，P = 0.003;无进展生存期5.6 v4.4年，P = 0.054）。在单变量和多变量分析中，诊断时年龄小于或等于40岁，癫痫发作，术后残留肿瘤最少，Karnofsky体力状态大于或等于70，少突胶质细胞瘤或混合胶质细胞瘤病理与中位生存期显著延长相关。放疗延迟至肿瘤进展（v立即放射治疗）与单变量的生存期延长相关，但其他变量的不平衡解释了这一优势，因此放射治疗的时机不是独立的结论：经现代影像学诊断的低级别胶质瘤患者可预期较长的生存时间;放射治疗的时机可能是一个不太重要的生存决定因素比非治疗变量和残留肿瘤体积。
Purpose: 29 review the outcomes of patients with low-grade glioma diagnosed by modern imaging and treated at a center where postponing radiotherapy was common practice.Methods: We reviewed the records of patients (age greater than or equal to 18 years) with pathologically confirmed supratentorial low-grade fibrillary astrocytoma, oligodendroglioma, and mixed glioma treated at a regional cancer center in Canada between 1979 and 1995.Results: Median survival for the entire group (N = 167; mean age 40.6 years) was 10.5 years with 5- and 10-year survival rates of 72% and 50%, respectively. Median progression-free survival was 4.9 years with 5- and 10-year progression-free rates of 50% and 12%, respectively. Overall and progression-free survivals were longer for patients with an oligodendroglioma or mixed glioma than with astrocytoma (median 13 v 7.5 years, P = .003; progression-free 5.6 v 4.4 years, P = .054). Age at diagnosis less than or equal to 40 years, seizures at presentation, minimal residual tumor after surgery, Karnofsky performance status greater than or equal to 70, and oligodendroglioma or mixed glioma pathology were associated with significantly longer median survival on univariate and multivariate analyses. Radiotherapy deferred until tumor progression (v immediate radiotherapy) was associated with longer survival on univariate a no lysis, but an imbalance in other variables accounted for this advantage such that timing of radiotherapy was not an independent (favorable or adverse) prognostic factor on multivariate analysis.Conclusion: patients with low-grade glioma diagnosed by modern imaging can be expected to live a long time; timing of radiotherapy may be a less important determinant of survival than nontreatment variables and residual tumor bulk.