SURVIVAL IN PATIENTS WITH RECURRENT GLIOMA AS A MEASURE OF TREATMENT EFFICACY - PROGNOSTIC FACTORS FOLLOWING NITROSOUREA CHEMOTHERAPY

The assessment of efficacy of treatment in patients with recurrent gli oma is notoriously difficult, and survival is the most objective endpo int. Between 1970 and 1992, a cohort of 211 patients with recurrent gl ioma received nitrosourea-based chemotherapy at the time of disease pr ogression. The median survival from the start of chemotherapy was 7 mo nths, with 30% 1-year and 10% 2-year survival probabilities. One-year survival was 22% in 147 patients with recurrent high-grade astrocytoma , 41% in 37 patients with low-grade astrocytoma and 45% in 24 patients with oligodendroglioma. Age, histological grade and Karnofsky perform ance status (KPS) at recurrence were independent prognostic factors fo r survival on multivariate analysis. Based on patients' age, tumour gr ade and KPS, it was possible to define three distinct prognostic group s with 1-year survival probabilities of 60, 21 and 17% (P < 0.005). Re sponse to chemotherapy was difficult to assess but correlated with pro gnostic subgroup, with highest response rate (46%) in the most favoura ble group and lowest (13%) in the poor prognostic group. In patients w ith recurrent glioma, patient and tumour parameters are the major dete rminants of outcome which are identical to prognostic factors at the t ime of primary diagnosis. They can be used td provide prognostic infor mation for the individual patient, and to stratify patients particular ly in trials assessing the efficacy of novel treatments.