SURVIVAL, PROGNOSTIC FACTORS, AND THERAPEUTIC EFFICACY IN LOW-GRADE GLIOMA - A RETROSPECTIVE STUDY IN 379 PATIENTS

Purpose: We report survival, prognostic factors, and treatment efficac y in low-grade glioma. Patients and Methods: A total of 379 patients w ith histologic intracranial low-grade glioma received postoperative ra diotherapy (n = 361) and intraarterial carmustine (BCNU) chemotherapy (n = 153). Overall survival and prognostic factors were evaluated with the SPSS statistical program (SPSS inc, Chicago, IL). Results: Median survival (all patients) was 100 months (95% confidence interval [CI], 87 to 113); in age group 0 to 19 years (n = 41), 226 months; in age g roup 20 to 49 years (n = 263), 106 months; in age group 50 to 59 years (n = 49), 76 months; and for older patients (n = 26), 39 months. Proj ected survival at 10 and 15 years was 42% and 29%, respectively. Patie nt age, World Health Organization (WHO) performance status, tumor comp uted tomography (CT) contrast enhancement, mental changes, or initial corticosteroid dependency were significant independent prognostic fact ors (P < .05), while histologic subgroup, focal deficits, presence of seizures, prediagnostic symptom duration, tumor category, and tumor st age were not, Patients aged 20 to 49 years with no independent negativ e prognostic factors in = 132) had a median survival time of 139 month s versus 41 months in patients with two or more factors (n = 33). Pati ents who presented with symptoms of expansion (n = 97) survived longer when resected (P < .03); otherwise no survival benefit was associated with initial tumor resection compared with biopsy. Intraarterial chem otherapy and radiation doses more than 55 Gy were not associated with prolonged survival, Among 66 reoperated patients, 45% progressed to hi gh-grade histology within 25 months. Conclusion: Prognosis in low-grad e glioma following postoperative radiotherapy seems largely determined by the inherent biology of the glioma and patient age at diagnosis. ( C) 1997 by American Society of Clinical Oncology.