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Validation of the Medical Research Council and A Newly Developed Prognostic Index in Patients with Malignant Glioma: How useful are Prognostic Indices in Routine Clinical Practice?

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Abstract

Although different prognostic indices for malignant gliomas have been developed, their validity outside of clinical trials has not been widely tested. The aim of this study was to determine whether the Medical Research Council (MRC) brain tumour prognostic index was able to stratify patients for survival managed in routine practice, and secondly to compare the results with our newly developed prognostic score which included tumour grade and only 3 prognostic groups. The MRC and the new prognostic index were calculated for a group of 119 adult patients with malignant glioma managed by surgical resection/biopsy and post-operative radiotherapy. For the MRC and new score, 6 and 3 prognostic groups were defined, respectively. For all patients median survival was 11 (2–66) months. The overall survival rate at 12 and 24 months were 43% and 18%, respectively. The MRC median and two-year survival rates were 14 months and 26% for a score of 1–10, 14 months and 27% for a score of 11–15, 13 months and 22% for a score of 16–20, 8 months and 10% for a score of 21–25, 8 months and 0% for those scoring 26–33. There was only one patient in the 34–38 group. For the new prognostic index, median and two-year survival rates were respectively 16 and 26%; 12 and 23%; 8 and 7% for the good, intermediate and poor prognostic groups. Both indices were significant factors for survival in univariate analysis (MRC index, p = 0.0089, new index p = 0.0002), but not in multivariate analysis. Both the MRC and our newly devised prognostic score were able to separate patients into good and poor prognostic groups, which may aid in treatment decisions, although there was less differentiation between the MRC groups especially over the first year. Both scores use routinely available factors. However, inclusion of tumour grade in the new score may be an advantage over the MRC index.

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References

  1. Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, Hatlevoll R, Lindgren M, Brun A, Lindgren S, Notter G, Anderson AP, Elgen K: Combined modality therapy of operated astrosytomas grades III and IV. Confirmation of the value of post-operative irradiation and lack of potentiation of bleomycin on survival time. Cancer 47: 649–652, 1981

    Google Scholar 

  2. Walker MD, Alexander E, Hunt WE, MacCarty CS, Mahaley MS, Mealy J, Norrel HA, Owens G, Ransohoff J, 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

    Google Scholar 

  3. Chang CH, Horton J, Schoenfeld D, Salazar O, Perez-Tamayo R, Kramer S, Weinstein A, Nelson JS, Tsukada Y: Comparison of post-operative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. Cancer 52: 997–1007, 1983

    Google Scholar 

  4. Walker MD, Green SB, Byar DP, Alexander E, Batzdorf U, Brooks WH, Hunt WE, Maccarty CS, Mahaley MS, Mealey J, Owens G, Ransohof J, Robertson JT, Shapiro WR, Smith KR, Wilson CB, Strike TA: A randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 303: 1323–1329, 1980

    Google Scholar 

  5. Werner-Wasik M, Scott CB, Nelson DF, Gaspar LE, Murray KJ, Fischbach JA, Nelson JS, Weinstein AS, Curran WJ: Final report of phase I/II trial of hyperfractionated and accelerated hyperfractionated radiation therapy with carmustine for adults with supratentorial malignant gliomas. Radiation Therapy Oncology Group Study 83–02. Cancer, 77(8): 1535–1543, 1996

    Google Scholar 

  6. Buatti JM, Marcus RB, Mendenhall WM, Friedman WA, Bova FJ: Accelerated hyperfractionated radiotherapy for malignant gliomas. Int J Radiat Oncol Biol Phys 34(4): 785–792, 1996

    Google Scholar 

  7. Brada M, Sharpe G, Rajan B, Britton J, Wilkins PR, Guerrero D, Hines F, Traish D, Ashley S: Modifying radical radiotherapy in high grade gliomas: shortening the treatment time through acceleration. Int J Radiat Oncol Biol Phys 43(2): 287–292, 1999

    Google Scholar 

  8. Fulton DS, Urtasun RC, Shin KH, Geggie PHS, Thomas H, Muller PJ, Moody J, Tanasichuk H, Mielke B, Johnson E, Curry B: Misonidasole combined with hyperfractionation in the management of malignant glioma. Int J Radiat Oncol Biol Phys 10: 1709–1712, 1984

    Google Scholar 

  9. Keim H, Potthoff PC, Schmidt K, Schiebush M, Neiss A, Trott KR: Survival and quality of life after continuous accelerated radiotherapy of glioblastomas. Radiother Oncol 9: 21–26, 1987

    Google Scholar 

  10. Payne DG, Simpson WJ, Keen C, Platts ME: Malignant astrocytoma. Hyperfractionated and standard radiotherapy with chemotherapy in a randomized prospective clinical trial. Cancer 50: 2301–2306, 1982

    Google Scholar 

  11. Shin KH, Muller PJ, Geggie PHS: Superfractionation radiation therapy in the treatment of malignant astrocytoma. Cancer 52: 2040–2043, 1983

    Google Scholar 

  12. Shapiro WR, Green SB, Burger PC, Mahaley MS, Selker RG, VanGilder JC, Robertson JT, Ransohoff J, Mealey J, Strike TA, Pistenmaa DA: Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 71: 1–9, 1989

    Google Scholar 

  13. Huncharek M, Muscat J, Geschwind JF: Multi-drug versus single agent chemotherapy for high grade astrocytoma; results of a meta-analysis. Anticancer Res 18(6B): 4693–4697, 1998

    Google Scholar 

  14. Rajkumar SV, Buckner JC, Schomberg PJ, Reid JM, Bagniewski PJ, Ames MM, Cascino TL, Marks RS: Phase I and pharmacokinetic study of preirradiation chemotherapy with BCNU, cisplatin, etoposide, and accelerated radiation therapy in patients with high-grade glioma. Int J Radiat Oncol Biol Phys 42(5): 969–975, 1998

    Google Scholar 

  15. Groves MD, Maor MH, Meyers C, Kyritsis AP, Jaeckle KA, Yung WK, Sawaya RE, Hess K, Bruner JM, Peterson P, Levin VA: A phase II trial of high-dose bromodeoxyuridine with accelerated fractionation radiotherapy followed by procarbazine, lomustine, and vincristine for glioblastoma multiforme. Int J Radiat Oncol Biol Phys 45(1): 127–35, 1999

    Google Scholar 

  16. By the Medical Research Council Brain Tumour Working Party: Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma. A Medical Research Council Trial. 19(2): 509–518, 2001

    Google Scholar 

  17. A report of the Medical Research Council Brain Tumour Working Party: Prognostic factors for high-grade malignant glioma: development of a prognostic index. J Neuro-Oncol 9: 47–55, 1990

    Google Scholar 

  18. Latif AZN, Signori D, Gregor A, Grant R, Ironside JW, Whittle IR: Application of the MRC brain tumour prognostic index to patients with malignant glioma not managed in randomised control trial. J Neurol Neurosurg Psychiatry 64: 747–750, 1998

    Google Scholar 

  19. Winger MJ, Macdonald DR, Cairncross JG: Supratentorial anaplastic gliomas in adults: The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 71: 487–493, 1989

    Google Scholar 

  20. Nemoto K, Ogawa Y, Matsushita H, Takeda K, Takahashi C, Fujimoto K, Nomiya T, Saito H, Takai Y, Yamada S: Radiation therapy with uneven fractionation for malignant gliomas. Oncol Rep 8(1): 103–106, 2001

    Google Scholar 

  21. Anders K, Grabenbauer GG, Schuchardt U, Fahlbusch R, Fietkau R, Sauer R, Krauseneck P: Accelerated radiotherapy with concomitant ACNU/Ara-C for the treatment of malignant glioma. J Neuro-Oncol 48(1): 63–73, 2000

    Google Scholar 

  22. Kleihues P, Burger PC, Sceithauer BW: The new WHO classification of brain tumors. Brain Pathol 3: 255–268, 1993

    Google Scholar 

  23. Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fischbach J, Isaacson S, Rotman M, Asbell SO, Nelson JS: 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(2): 239–244, 1993

    Google Scholar 

  24. Perry A, Jenkins RB, O'Fallon JR, Schaefer PL, Kimmel DW, Mahoney MR, Scheithauer BW, Smith SM, Hill EM, Sebo TJ, Levitt R, Krook J, Tschetter LK, Morton RF, Buckner JC: Clinicopathologic study of 85 similarly treated patients with anaplastic astrocytic tumors. An analysis of DNA content (ploidy), cellular proliferation, and p53 expression. Cancer 15; 86(4): 672–683, 1999

    Google Scholar 

  25. Shinoda J, Sakai N, Murase S, Yano H, Matsuhisa T, Funakoshi T: Selection of eligible patients with supratentorial glioblastoma multiforme for gross total resection. J Neuro-Oncol 52(2): 161–171, 2001

    Google Scholar 

  26. Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Nelson DF, Fischbach AJ, Chang CH, Rotman M, Asbell SO: Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)?A report from three Radiation Therapy Oncology Group (RTOG) trials. J Neurooncol 12(3): 219–227, 1992

    Google Scholar 

  27. Prados MD, Gutin PH, Phillips TL, Wara WM, Larson DA, Sneed PK, Davis RL, Ahn DK, Lamborn K, Wilson CB: Highly anaplastic astrocytoma: a rewiew of 357 patients treated between 1977 and 1989. Int J Radiat Oncol Biol Phys 23: 3–8, 1992

    Google Scholar 

  28. Levin VA, Prados MR, Wara WM, Davis RL, Gutin PH, Philips TL, Lamborn K, Wilson CB: Radiation therapy and bromodeoxyuridine chemotherapy followed by procarbazine, lomustine, and vincristine for the treatment of anaplastic gliomas. Int J Radiat Oncol Biol Phys 32(1): 75–83, 1995

    Google Scholar 

  29. Sarkaria JN, Mehta MP, Loeffler JS, Buatti JM, Chappell RJ, Levin AB, Alexander E, Friedman WA, Kinsella TJ: Radiosurgery in the initial management of malignant gliomas: survival comparison with the RTOG recursive partitioning analysis. Int J Radiat Oncol Biol Phys 32(4): 931–941, 1995

    Google Scholar 

  30. Phuphanich S, Ferrall S, Greenberg H: Long-term survival in malignant glioma. Prognostic factors. J Fla Med Assoc 80(3): 181–184, 1993

    Google Scholar 

  31. Wurschmidt F, Bunemann H, Heilmann HP: Prognostic factors in high-grade malignant glioma. A multivariate analysis of 76 cases with postoperative radiotherapy. Strahlenther Onkol 171(6): 315–321, 1995

    Google Scholar 

  32. Beck-Bornholdt HP, Dubben HH: Potential pitfalls in the use of p-values and in interpretation on significance levels. Radiother Oncol 33(2): 171–176, 1994

    Google Scholar 

  33. MRC Working Party on Misonidazole in Gliomas: A study of the effect of misonidazole in conjunction with radiotherapy for the treatment of grades 3 and 4 astrocytoma. Br J Radiol 56: 673–682, 1983

    Google Scholar 

  34. Bleehen NM, Slenning SP: A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. The Medical Research Council Brain Tumour Working Party. Br J Cancer 64(4): 769–774, 1991

    Google Scholar 

  35. Shibamoto Y, Yamashita J, Takahashi M, Yamasaki T, Kikuchi H, Abe M: Supratentorial malignant glioma: an analysis of radiation therapy in 178 cases. Radiother Oncol 18(1): 9–17, 1990

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Dokuz Eylül University, Medical School, Izmir, Turkey

    Fadime Akman, Rachel A. Cooper, Mehmet Şen, Yildiray Tanriver & Süleyman Kentli

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  1. Fadime Akman
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  2. Rachel A. Cooper
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  3. Mehmet Şen
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Akman, F., Cooper, R.A., Şen, M. et al. Validation of the Medical Research Council and A Newly Developed Prognostic Index in Patients with Malignant Glioma: How useful are Prognostic Indices in Routine Clinical Practice?. J Neurooncol 59, 39–47 (2002). https://doi.org/10.1023/A:1016353614525

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