Journal of Clinical Oncology, Vol 11, 857-862, Copyright © 1993 by American Society of Clinical Oncology
Survival comparison of radiosurgery-eligible and -ineligible malignant glioma patients treated with hyperfractionated radiation therapy and carmustine: a report of Radiation Therapy Oncology Group 83-02
WJ Curran Jr, CB Scott, AS Weinstein, LA Martin, JS Nelson, TL Phillips, K Murray, AJ Fischbach, D Yakar and JG Schwade
Fox Chase Cancer Center, Philadelphia, PA 19111.
PURPOSE: The purpose is twofold: (1) to identify the malignant glioma
patients treated in a trial of hyperfractionated radiotherapy (RT) and
carmustine (BCNU) who may have been eligible for a stereotactic
radiosurgery (SRS) boost; and (2) to compare survival of such patients with
that of those considered SRS-ineligible. PATIENTS AND METHODS: From January
1983 to July 1989, 778 malignant glioma patients were enrolled on Radiation
Therapy Oncology Group (RTOG) 83-02, a randomized phase I/II
hyperfractionated RT dose-escalation trial with BCNU chemotherapy. The SRS
criteria used in a single-institution trial were applied to these patients;
they are: Karnofsky performance status (KPS) of greater than 60;
well-circumscribed tumor less than 4.0 cm; no subependymal spread; and a
location not adjacent to brainstem or optic chiasm. RESULTS: Eighty-nine
patients (11.9%) were identified as potentially SRS-eligible. The median
survival times (MST) and 18-month survival rates of the 89 eligible and 643
ineligible patients were 14.4 versus 11.7 months and 40% versus 27%,
respectively (P = .047). The MST and 18-month survival rate of the 544
SRS-ineligible patients with KPS greater than 60 were 12.1 months and 29%,
respectively, and were not statistically inferior to the survival of the
SRS-eligible group (P = .21). Multivariate analysis revealed age, KPS, and
histopathology to be strongly predictive of survival, and SRS eligibility
was also significantly predictive (P = .047). CONCLUSION: SRS-eligible
patients enrolled on RTOG 83-02 had survival superior to that of the SRS-
ineligible group, and this advantage is mainly due to the selection of a
subgroup with a high minimum KPS.
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