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Prognostic value of a clinical-histological “glioma score”
S225
Poster Presentations
Thursday, 10 July 1997
P-5
14:00-16:15
Tumours of the eNS - Gliomas
IP-5-531 I An interdisciplinary-scare-system for astrocytomas S. Weis ' . K. Oppenrieder1• T. Hagen 2 , PA Winkler 3 . 1lnslitute of Neuropathofogy, Universityof Munich, Germany. 3 Department of Neurosurgery. University of Munich Germany, 2 Division of Neuroradiology. University of Saarland. Homburg, Germany Introduction: Basedon their biologicbehaviorthree differenttypesof astrocytic tumors may be distinguished: astrocytoma (grade II), anaplastic astrocytoma (grade ill), and glioblastoma (grade IV). The aim of the present study was to analyze which parameters derived from neuropathology, surgery, and radiology allow the most reliable classification into these three grades. Furthermore. based on a variety of parameters, a score was calculated and correlated with the survival of the patients. Methods: A retrospective study was carried out on 146 patientswho underwent tumor resection in 1988 and 1989. For the analysis various parameters were used: histology(cell density and atypia, nuclear atypia. mitoses, endothelial proliferation, and necrosis), surgery (location, mass effect, resectability, accessibility and intraoperative characteristics), CT/MRI (signal density/intensity, contrast enhancement, edema, and cystic areas). A value of 0 or 1 was attributed to each parameteraccording to absenceor presencerespectively and summed up. Results: The survival was as follows: grade II (29% of the patients) 56.06 months, grade III (9%) 18.97 months, and grade IV (62%) 9.63 months. The presenceof necrosis was the discriminant factor for delineating grade IV from grade III. The neuropathology-score correlated highly significantly with survival (r = -0.95, P < 0.(01), whereas no significant correlation was found for the surgeryor radiology-score. Discussion and Conclusion: Grade III can reliably be distinguished from gradeII by celldensityand atypia. Necrosisis the clear-cutparameter separating grade IV from grade III. Parametersfrom surgery and radiology did not reliably contributeto the correctclassification into the three gradesand their respective scores did not correlatewell with survival,
I P-5-532I
Prognostic value of a clinical-histological "glioma score"
Luciano Mastronardi, Antonio Guiducci1 • Cristina Spera, Alessio Albanese, Giulio Maira. Dep. Neurol.Sci., Neurosurgery. Civilian Hospital of Temi, 1 Institute of Pathological Anatomy. Civilian Hospital of Terni We propose a "glioma score" (GS) with a possible prognostic value in patients operated on for cerebral high-grade gliomas. It considers 4 variables: age at diagnosis (:560 y = 0 pt: >60 y = 1 pt), Kamofski Performance Status (KPS 2: 70 = 0 pt; <70 = 1 pt), histological WHO grade (III =0 pt; IV = 1 pt), and Ki67 Labeling Index (L1 :s 25 = 0 pt; > 25 = 1 pt). In relation to the score, it is possible to classify the patients in 5 groups (G-IV), with a presumable ditterent prognosis. This GS has been appliedon a seriesof 25 patientsoperated on and treated with multimodal adjuvant therapy. There were 17 males and 8 females, with a median age of 48 years; 14 patients were over-60. The pre-operative KPS rangedfrom 40 to 100 (median80). Surgical removal was total in 14cases and subtotal in 11 . The tumor was a III WHO grade in 5 cases and a IV grade in 20. The Ki67 U was evaluated with the monoclonal anlibody MIB-l : it ranged from 2.30 to 62 (median 25). Twentythree patients received a post-operative treatment with oral adminis1ration of tamoxifen (40, 80 or 120 mg/day), i.v, carboplatin (45D-600 mg/m2 ) , and radiotherapy (45llO-6OO0 cGy); 2 patients receivedonly radiotherapy at the same doses. The overall survivalranges from 3 to 52 months; 6 patients are still alive. Two patients were classified as GS O. 8 GS I, 7 GS II, 6 GS III and 2 GS IV. With the aim to reduce the number of subgroups and to consent a more reliable statistical evaluation, we considered 3 prognostic classes: A (groups G-I), B (II-III) , and C (IV). The median survival evaluated by means of the Kaplan-Meyer method was: 30 months in patients belonging to class A, 11 months class B, and 9 months for class C. These differences of survival rate proved to be statistically significant (p = 0.03). In relation to our preliminary
results and to the facility of application, the proposed "glioma score" could be used as a prognostic indicator in patientswith high-gradecerebral gliomas.
IP-5-533I cerebral Study of clinical stages and CSRCI scheme of gliomas So Peng, ShuganZhu, ZhzyongVan. Department of Neurosurgery. The AffiliatedHospitalof Shandong MedicalUniversity. Jinan, PR China Basedupon 103patients' clinical, CT and MRI manifestic pathology, the authors elaborated a (new) staging system for cerebral gliomas (for the first time) which may play an important role in assessing prognosis and choosing proper treatment. The CSRCI protocolincludesthe following.Three monthsfollowing surgery, gross removal of cerebral gliomas,the patient in offered should have radiotherapy by linear accelerator. Nine and fifteen months after operation, the patient is treated with low doses chemotherapy administered to the tumor by selective catheterization, in addition the patient should have immunotherapy every year after operation. Satisfying results were obtained in 22 cases treated by this scheme. It is one of the most effectivemethods of treatment to cerebral gliomas until date.
IP-5-534I Surgical management of glioblastoma multiforme M.a. Pinsker, C.B. Lumenta. Department of Neurosurgery. Academic Hospital Munich-Bogenhausen, Germany Introduction: Among braintumoursthe glioblastomamultiformehasthe poorest prognosis. The influence of surgical treatment on survival and life quality was investigated. Methods: 145 patients surgically treated at our department from January 1993 to August 1996 were evaluated. Patients underwent various combinations of stereotactic surgery (STX), gross totaVsubtotal resection surgery and radiotherapy. Results: We operated 145 patients, 87 (60%) male, 58 (40%) female. Mean agewas 57.9 years. In 69 (48%) patientsthe tumour exceeded5 cm in diameter (including multifocal), in 76 (52%) diameter was less than 5 em. We differentiated five surgicalsubgroups: group I stereotactic (STX) biopsy only, group II STX biopsy followed by subtotallincomplete resection, group 1/1 STXbiopsyfollowedby grosstotal resection, groupIV subtotal resectionwithout previous STX biopsy and group V gross total resection without STX biopsy. Mean age of group I was with 62.3 years; higher than in all the other groups. Discharge Karnofsky index was about to points higher than at admission, except in group I and II. Nearly 60% of the patients in group I and II had a glioblastoma larger than 5 em, but clearly less than 50% of the patients from the other groups had tumours of this size. 110/145 (76%) patients underwent adjuvantradiation therapywith a mean dose of 54.0 Gray (SD-l0.8) about 4-6 weeks after surgery. At this moment of follow-up patients who underwent complete resection survived in mean 11 .6 months, seven of them were still alive more than 17.7 months. After subtotal or incomplete resection mean survival was lower with in mean 7.5 months and after stereotactic biopsy without following surgery mean survival was only 4.2 months. Discussion: We recommended an extensive, gross total resection in all cases if this is possible without risking too serious neurological deficits. Every treatment should be followed by adjuvant therapy, Le. radiation and/or chemotherapy.
IP-S-53SI treatment Long-term follow-up in young patients after complex for cerebellar astrocytoma A.P.Petkov, N.D. Marinov. L.A. Petrov. Military Medical Academy, Sofia, Bulgaria The aim of this paper is to underline a good outcome in young patients with cerebellar astrocytomas treated surgically and with radiotherapy. 31 patients between9 and 16years underwent for neocerebellarastrocytomas (grade I-IV) surgeryand radiotherapy. Of them 26 (84%) were female, 5 (16%) - male. The mediumfollowup period is 7.3 years (from6 to 14years). Duringthis perioddied only 4 patients. Low grade were 18 hemisphericand 5 vermiantumors, while 8 malignant astrocytomas were hemispherically located. Lateral, paramedian and mediansuboccipital decompressive craniectomy, without removal of the dorsal arch of the Ct were used. The surgical technique involved central debulking,
Poster Presentations
Thursday, 10 July 1997
P-5
14:00-16:15
Tumours of the eNS - Gliomas
IP-5-531 I An interdisciplinary-scare-system for astrocytomas S. Weis ' . K. Oppenrieder1• T. Hagen 2 , PA Winkler 3 . 1lnslitute of Neuropathofogy, Universityof Munich, Germany. 3 Department of Neurosurgery. University of Munich Germany, 2 Division of Neuroradiology. University of Saarland. Homburg, Germany Introduction: Basedon their biologicbehaviorthree differenttypesof astrocytic tumors may be distinguished: astrocytoma (grade II), anaplastic astrocytoma (grade ill), and glioblastoma (grade IV). The aim of the present study was to analyze which parameters derived from neuropathology, surgery, and radiology allow the most reliable classification into these three grades. Furthermore. based on a variety of parameters, a score was calculated and correlated with the survival of the patients. Methods: A retrospective study was carried out on 146 patientswho underwent tumor resection in 1988 and 1989. For the analysis various parameters were used: histology(cell density and atypia, nuclear atypia. mitoses, endothelial proliferation, and necrosis), surgery (location, mass effect, resectability, accessibility and intraoperative characteristics), CT/MRI (signal density/intensity, contrast enhancement, edema, and cystic areas). A value of 0 or 1 was attributed to each parameteraccording to absenceor presencerespectively and summed up. Results: The survival was as follows: grade II (29% of the patients) 56.06 months, grade III (9%) 18.97 months, and grade IV (62%) 9.63 months. The presenceof necrosis was the discriminant factor for delineating grade IV from grade III. The neuropathology-score correlated highly significantly with survival (r = -0.95, P < 0.(01), whereas no significant correlation was found for the surgeryor radiology-score. Discussion and Conclusion: Grade III can reliably be distinguished from gradeII by celldensityand atypia. Necrosisis the clear-cutparameter separating grade IV from grade III. Parametersfrom surgery and radiology did not reliably contributeto the correctclassification into the three gradesand their respective scores did not correlatewell with survival,
I P-5-532I
Prognostic value of a clinical-histological "glioma score"
Luciano Mastronardi, Antonio Guiducci1 • Cristina Spera, Alessio Albanese, Giulio Maira. Dep. Neurol.Sci., Neurosurgery. Civilian Hospital of Temi, 1 Institute of Pathological Anatomy. Civilian Hospital of Terni We propose a "glioma score" (GS) with a possible prognostic value in patients operated on for cerebral high-grade gliomas. It considers 4 variables: age at diagnosis (:560 y = 0 pt: >60 y = 1 pt), Kamofski Performance Status (KPS 2: 70 = 0 pt; <70 = 1 pt), histological WHO grade (III =0 pt; IV = 1 pt), and Ki67 Labeling Index (L1 :s 25 = 0 pt; > 25 = 1 pt). In relation to the score, it is possible to classify the patients in 5 groups (G-IV), with a presumable ditterent prognosis. This GS has been appliedon a seriesof 25 patientsoperated on and treated with multimodal adjuvant therapy. There were 17 males and 8 females, with a median age of 48 years; 14 patients were over-60. The pre-operative KPS rangedfrom 40 to 100 (median80). Surgical removal was total in 14cases and subtotal in 11 . The tumor was a III WHO grade in 5 cases and a IV grade in 20. The Ki67 U was evaluated with the monoclonal anlibody MIB-l : it ranged from 2.30 to 62 (median 25). Twentythree patients received a post-operative treatment with oral adminis1ration of tamoxifen (40, 80 or 120 mg/day), i.v, carboplatin (45D-600 mg/m2 ) , and radiotherapy (45llO-6OO0 cGy); 2 patients receivedonly radiotherapy at the same doses. The overall survivalranges from 3 to 52 months; 6 patients are still alive. Two patients were classified as GS O. 8 GS I, 7 GS II, 6 GS III and 2 GS IV. With the aim to reduce the number of subgroups and to consent a more reliable statistical evaluation, we considered 3 prognostic classes: A (groups G-I), B (II-III) , and C (IV). The median survival evaluated by means of the Kaplan-Meyer method was: 30 months in patients belonging to class A, 11 months class B, and 9 months for class C. These differences of survival rate proved to be statistically significant (p = 0.03). In relation to our preliminary
results and to the facility of application, the proposed "glioma score" could be used as a prognostic indicator in patientswith high-gradecerebral gliomas.
IP-5-533I cerebral Study of clinical stages and CSRCI scheme of gliomas So Peng, ShuganZhu, ZhzyongVan. Department of Neurosurgery. The AffiliatedHospitalof Shandong MedicalUniversity. Jinan, PR China Basedupon 103patients' clinical, CT and MRI manifestic pathology, the authors elaborated a (new) staging system for cerebral gliomas (for the first time) which may play an important role in assessing prognosis and choosing proper treatment. The CSRCI protocolincludesthe following.Three monthsfollowing surgery, gross removal of cerebral gliomas,the patient in offered should have radiotherapy by linear accelerator. Nine and fifteen months after operation, the patient is treated with low doses chemotherapy administered to the tumor by selective catheterization, in addition the patient should have immunotherapy every year after operation. Satisfying results were obtained in 22 cases treated by this scheme. It is one of the most effectivemethods of treatment to cerebral gliomas until date.
IP-5-534I Surgical management of glioblastoma multiforme M.a. Pinsker, C.B. Lumenta. Department of Neurosurgery. Academic Hospital Munich-Bogenhausen, Germany Introduction: Among braintumoursthe glioblastomamultiformehasthe poorest prognosis. The influence of surgical treatment on survival and life quality was investigated. Methods: 145 patients surgically treated at our department from January 1993 to August 1996 were evaluated. Patients underwent various combinations of stereotactic surgery (STX), gross totaVsubtotal resection surgery and radiotherapy. Results: We operated 145 patients, 87 (60%) male, 58 (40%) female. Mean agewas 57.9 years. In 69 (48%) patientsthe tumour exceeded5 cm in diameter (including multifocal), in 76 (52%) diameter was less than 5 em. We differentiated five surgicalsubgroups: group I stereotactic (STX) biopsy only, group II STX biopsy followed by subtotallincomplete resection, group 1/1 STXbiopsyfollowedby grosstotal resection, groupIV subtotal resectionwithout previous STX biopsy and group V gross total resection without STX biopsy. Mean age of group I was with 62.3 years; higher than in all the other groups. Discharge Karnofsky index was about to points higher than at admission, except in group I and II. Nearly 60% of the patients in group I and II had a glioblastoma larger than 5 em, but clearly less than 50% of the patients from the other groups had tumours of this size. 110/145 (76%) patients underwent adjuvantradiation therapywith a mean dose of 54.0 Gray (SD-l0.8) about 4-6 weeks after surgery. At this moment of follow-up patients who underwent complete resection survived in mean 11 .6 months, seven of them were still alive more than 17.7 months. After subtotal or incomplete resection mean survival was lower with in mean 7.5 months and after stereotactic biopsy without following surgery mean survival was only 4.2 months. Discussion: We recommended an extensive, gross total resection in all cases if this is possible without risking too serious neurological deficits. Every treatment should be followed by adjuvant therapy, Le. radiation and/or chemotherapy.
IP-S-53SI treatment Long-term follow-up in young patients after complex for cerebellar astrocytoma A.P.Petkov, N.D. Marinov. L.A. Petrov. Military Medical Academy, Sofia, Bulgaria The aim of this paper is to underline a good outcome in young patients with cerebellar astrocytomas treated surgically and with radiotherapy. 31 patients between9 and 16years underwent for neocerebellarastrocytomas (grade I-IV) surgeryand radiotherapy. Of them 26 (84%) were female, 5 (16%) - male. The mediumfollowup period is 7.3 years (from6 to 14years). Duringthis perioddied only 4 patients. Low grade were 18 hemisphericand 5 vermiantumors, while 8 malignant astrocytomas were hemispherically located. Lateral, paramedian and mediansuboccipital decompressive craniectomy, without removal of the dorsal arch of the Ct were used. The surgical technique involved central debulking,