GOOD PERFORMANCE STATUS OF LONG-TERM DISEASE-FREE SURVIVORS OF INTRACRANIAL GLIOMAS

Purpose: To determine the long-term impact on function of treatment fo r primary cerebral gliomas, Karnofsky Performance Status, employment h istory, and memory function were used to evaluate the status of adults who are alive and disease-free more than 1 year after cranial irradia tion. Methods and Materials: Of 30 eligible adult patients, seventeen patients had anaplastic astrocytoma, seven had a glioblastoma, four ha d low grade astrocytoma, one had a mixed glioma, and one had an anapla stic oligodendroglioma. Sixteen patients received partial brain irradi ation only, 12 had whole brain irradiation with a partial brain boost, and two had whole brain irradiation only. The total dose ranged from 54-66 Gy, with a fraction size of 1.7-2.0 Gy. Median follow-up was 3.5 years. Eighty-three percent of patients also received adjuvant chemot herapy. Results: Karnofsky Performance Status generally remained stabl e after the completion of irradiation. Mean Performance status was 84 at the end of irradiation and was unchanged at the time of last follow -up. The actuarial freedom from performance status decline after irrad iation was 93% at 5 years. The performance status increased in two pat ients, both within several months of completing irradiation. Most pati ents (68%) returned to work after irradiation. Sixty-two percent remai ned at work 1 year later, and 58% were working at the time of last fol low-up. No patient who did not return to work within 4 months of compl eting irradiation was able to work at a later date. All working patien ts were employed in a capacity similar to their pre-morbid position. O nly one patient, with an intercurrent lung cancer, eventually develope d deficits that limited self care. Conclusions: Contrary to previously published reports, long-term glioma survivors maintained a relatively good performance status in the absence of recurrence and did not expe rience a progressive decline in neuropsychologic function after comple tion of cranial irradiation. A patient's functional state at the compl etion of irradiation is a reliable predictor of long-term functional o utcome in the absence of recurrence. Although the number of patients i n each subgroup is small and no significant differences could be detec ted, patients treated with partial brain irradiation had a higher and more stable performance status, better memory function, and superior e mployment history.