Summary
Between 1988 and 1991, eighty-six patients with glioblastoma multiforme were evaluated in order to define the influence of extent of surgery and tumor location on treatment outcome. Patients underwent surgery followed by postoperative hyperfractionated radiotherapy and chemotherapy delivered according to one of two consecutive protocols. Surgery consisted of biopsy in 25 (29%) patients and subtotal or gross total tumor resection in 61 (71%) patients. Frontally located tumors were noted in 26 (30%) patients and other tumor locations were noted in 60 (70%) patients. Patients having more radical surgery had longer median survival time (MST) and higher 1- and 2-year survival rates than those with biopsy only (56 vs 29 weeks, respectively; 62 % and 23 % vs 16% and 0%, respectively; p=0.00000). Patients having frontally located tumors had longer MST and higher 1- and 2-year survival rates than those with other tumor locations (101 vs 47 weeks, respectively; 76% and 44% vs 37% and 2.5%, respectively; p=0.00001). Multivariate analysis confirmed that extent of surgery and tumor location were independent prognostic factors in patients with glioblastoma multiforme. Regarding progression-free survival, patients having more radical surgery had longer median time to tumor progression (MTP) than those with biopsy only (33 weeks vs 21 weeks, respectively). Also, progression-free survival at 1 year was higher in radically resected group than in biopsy only group (20% vs 0%, respectively; p=0.00000). Patients with frontally located tumors had longer MTP (42 weeks) and higher progression-free survival at 1 year (42%) than those with other tumor location (28 weeks and 1.7%, respectively; p=0.00002). Multivariate analysis confirmed that the extent of surgery and tumor location are independent prognosticators in patients with glioblastoma multiforme treated with combined modality approach using progression-free survival as an endpoint.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Walker MD, Alexander E, Hunt WE, MacCarty CS, Mahaley MS, Mealey MS Jr, Mealey MS Sr, Norrell HA, Owens G, Ranshoff JR, Wilson CB, Gehan EA, Strike TA: Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49: 333–343, 1978
Walker MD, Strike TA, Sheline GE: An analysis of doseeffect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 5: 1725–1731, 1979
Walker MD, Green SB, Byar DP, Alexander E, Batzdorf U, Brooks WH, Hunt WE, MacCarty CS, Mahaley MS, Mealey J, Owens G, Ranshoff J, Robertson JT, Shapiro WR, Smith KR, Wilson CB, Strike TA: Randomized comparison of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 303: 1323–1329, 1980
European Organization for Research on Treatment on Cancer (EORTC) Brain Tumor Group: Evaluation of CCNU, VM 26 plus CCNU, and procarbazine in supratentorial brain gliomas. Final evaluation of a randomized study. J Neurosurg 55: 27–31, 1981
Chang CH, Horton J, Schoenfeld D, Salazar O, Perez-Tamayo R, Kramer S, Weinstein A, Nelson JS, Tsukada Y: Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. Cancer 52: 997–1007, 1983
Wood JR, Green SB, Shapiro WR: The prognostic importance of tumor size in malignant gliomas: A computed tomography scan study by the Brain Tumor Cooperative Group. J Clin Oncol 6: 338–343, 1988
Winger MJ, MacDonald DR, Cairncross JG: Supratentorial anaplastic gliomas in adults. The prognostic criteria of extent of resection and prior low-grade glioma. J Neurosurg 71: 487–493, 1989
Nelson DR, Curran WJ, Scott C, Nelson JS, Weinstein AS, Ahmad K, Constine LS, Murray K, Powlis WD, Mohiuddin M, Fischbach J: Hyperfractionated radiation therapy and bis-chloroethyl nitrosourea in the treatment of malignant glioma — possible advantage observed at 72.0 Gy in 1.2 Gy b.i.d. fractions: report of The Radiation Therapy Oncology Group protocol 8302. Int J Radiat Oncol Biol Phys 25: 193–207, 1993
Jelsma R, Bucy PC: Glioblastoma multiforme. Its treatment and some factors effecting survival. Arch Neurol 20: 161–171, 1969
Scanlon PW, Taylop WF: Radiotherapy of intracranial astrocytomas: analysis of 417 cases treated from 1960 through 1969. Neurosurgery 5: 301–308, 1979
Devaux BC, O'Fallon JR, Kelly PJ: Resection, biopsy, and survival in malignant glial neoplasma. A retrospective study of clinical parameters, therapy, and outcome. J Neurosurg 78: 767–775 1993
Miller PJ, Hassanein RS, Shankar Giri PG, Kimler BF, O'Boynick P, Evans RG: Univariate and multivariate statistical analysis of high-grade gliomas: the relationship of radiation dose and other prognostic factors. Int J Radiat Oncol Biol Phys 19: 275–280, 1990
Kreth FW, Warnke PC, Scheremet R, Ostertag CB: Surgical resection and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78: 762–766, 1993
Gehan EA, Walker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46: 189–195, 1977
Coffey RJ, Lunsford LD, Taylor FH: Survival after stereotactic brain biopsy of malignant gliomas. Neurosurgery 22: 465–473, 1988
Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fischbach J, Isaacson S, Rotman M, Asbell SO, Nelson JS, Weinstein AS, Nelson DF: Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: Results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys 26: 239–244, 1993
Kelly PJ: Stereotactic technology in tumor surgery. Clin Neurosurg 35: 215–253, 1987
Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW, Illig JJ: Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66: 865–874, 1987
Kelly PJ, Kail BA, Goerss S, Earnest F: Computer-assisted laser resection of intra-axial brain neoplasms. J Neurosurg 64: 427–139, 1986
King RB, Schell GR: Cortical localization and monitoring during cerebral operations. J Neurosurg 67: 210–219, 1987
Roth JG, Elvidje AR: Glioblastoma multiforme: a clinical survey. J Neurosurg 17: 736–750, 1960
Taveras JM, Thompson HG Jr, Pool JL: Should we treat glioblastoma multiforme? A study of 425 cases. AJR 87: 473–79, 1962
Hitchcock E, Sato F: Treatment of malignant gliomata. J Neurosurg 21: 497–505, 1964
Weir B: The relative significance of factors affecting postoperative survival in astrocytomas, grades 3 and 4. J Neurosurg 38: 448–552, 1973
Newell J, Ranshoff J, Kaplan B: Glioblastoma in an older patient. How long a course of radiotherapy is necessary? J Neurooncol 6: 325–327, 1988
Kinsella TJ, Coffins J, Rowland J, Klecker R Jr, Wright D, Katz D, Steinberg SM, Glatstein E: Pharmacology and phase I/II study of continuous intravenous infusions of iododeoxyuridine and hyperfractionated radiotherapy in patients with glioblastoma multiforme. J Clin Oncol 6: 871–879, 1988
Andreou J, George AE, Wise A, de Leon M, Kricheff II, Ranshoff J, Foo SH: CT prognostic criteria of survival after malignant glioma surgery. AJNR 4: 488–490, 1983
Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481, 1958
Cox DR: Regression models and life tables. J Royal Stat Soc (Series B) 34: 187–229, 1972
Hoshino T: A commentary on the biology and growth kinetics of low-grade and high-grade gliomas. J Neurosurg 61: 895–900, 1984
Levin VA, Huffman WF, Heilbron DC, Norman D: Prognostic significance of the pretreatment CT scan on the time to progression for patients with malignant gliomas. J Neurosurg 52: 642–647, 1980
Murovic J, Turowski K, Wilson CB, Hoshino T, Levin V: omputerized tomography in the prognosis of malignant cerebral gliomas. J Neurosurg 65: 799–806, 1986
Reeves GI, Marks JE: Prognostic significance of lesion size for glioblastoma multiforme. Radiology 132: 469–471, 1979
Nazzaro JM, Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73: 331–344, 1990
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jeremic, B., Grujicic, D., Antunovic, V. et al. Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach. J Neuro-Oncol 21, 177–185 (1994). https://doi.org/10.1007/BF01052902
Issue Date:
DOI: https://doi.org/10.1007/BF01052902