Journal of Clinical Oncology, Vol 6, 338-343, Copyright © 1988 by American Society of Clinical Oncology
The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group
JR Wood, SB Green and WR Shapiro
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10021.
The prognostic importance of tumor size was studied in 510 patients with
malignant glioma (80% with glioblastoma multiforme) in the Valid Study
Group of Study 80-01 of the Brain Tumor Study Group (now the Brain Tumor
Cooperative Group [BTCG]). The endpoint was length of survival from
randomization, which occurred within 3 weeks of definitive surgery.
Following randomization, patients were scheduled to receive radiotherapy
(RT) (6,020 cGy) during a 7-week period, along with continuing courses of
chemotherapy. Computed tomographic (CT) scan information was available for
124 patients preoperatively, 300 patients postoperatively (preradiation),
and 218 patients 9 weeks post-RT (+/- 3 weeks). Tumor size was determined
as area (length x width) on the contrast-enhanced scan and survival was
compared by log rank statistics. Preoperative tumor area was unrelated to
survival (P = .48), but postoperative area was significantly prognostic (P
less than .0001); the smaller the residual tumor, the longer the patient
lived. Patients with a 75% or greater resection, as determined by measuring
the difference between the preoperative and the postoperative scans, tended
to have better survival, but the difference was not significant (P = .16).
The post-RT area was strongly related to survival (P less than .00001). The
percent change in area between the pre- and post-RT scans was also
prognostic. Tumor size was of prognostic importance independent of the
other known prognostic variables: age, Karnofsky performance score, and
whether the tumor was glioblastoma or anaplastic astrocytoma. We conclude
that the amount of tumor remaining after surgery is an important baseline
variable at the start of RT, and that the tumor size 9 weeks following RT
is also prognostic. Surgical resection is most important when it leaves the
least amount of residual tumor.
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