The relative value of postoperative versus preoperative Karnofsky Performance Scale scores as a predictor of survival after surgical resection of glioblastoma multiforme

2014 ◽  
Vol 121 (2) ◽  
pp. 359-364 ◽  
Author(s):  
Lola B. Chambless ◽  
Heather M. Kistka ◽  
Scott L. Parker ◽  
Laila Hassam-Malani ◽  
Matthew J. McGirt ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Karnofsky Performance Scale ◽  
Relative Value ◽  
Scale Scores ◽  
Performance Scale

EXTENT OF RESECTION AND SURVIVAL IN GLIOBLASTOMA MULTIFORME

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 564-576 ◽  
Author(s):  
◽  
Walter Stummer ◽  
Hanns-Jürgen Reulen ◽  
Thomas Meinel ◽  
Uwe Pichlmeier ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Scale Score ◽  
Aminolevulinic Acid ◽  
Residual Tumor ◽  
Complete Resection ◽  
Karnofsky Performance Scale ◽  
Resonance Imaging ◽  
Treatment Bias ◽  
Karnofsky Performance Scale Score ◽  
Performance Scale

Abstract OBJECTIVE The influence of the degree of resection on survival in patients with glioblastoma multiforme is still under discussion. The highly controlled 5-aminolevulinic acid study provided a unique platform for addressing this question as a result of the high frequency of “complete” resections, as revealed by postoperative magnetic resonance imaging scans achieved by fluorescence-guided resection and homogeneous patient characteristics. METHODS Two hundred forty-three patients with glioblastoma multiforme per protocol from the 5-aminolevulinic acid study were analyzed. Patients with complete and incomplete resections as revealed by early magnetic resonance imaging scans were compared. Prognostic factors that might cause bias regarding resection and influence survival (e.g., tumor size, edema, midline shift, location, age, Karnofsky Performance Scale score, National Institutes of Health Stroke Scale score) were used for analysis of overall survival. Time to reintervention (chemotherapy, reoperation) was analyzed further to exclude bias regarding second-line therapies. RESULTS Treatment bias was identified in patients with complete (n = 122) compared with incomplete resection (n = 121), i.e., younger age and less frequent eloquent tumor location. Other factors, foremost preoperative tumor size, were identical. Patients without residual tumor survived longer (16.7 versus 11.8 mo, P < 0.0001). In multivariate analysis, only residual tumor, age, and Karnofsky Performance Scale score were significantly prognostic. To account for distribution bias, patients were stratified for age (>60 or ≤60 yr) and eloquent location. Survival advantages from complete resection remained significant within subgroups, and age/eloquent location were no longer unevenly distributed. Reinterventions occurred marginally earlier in patients with residual tumor (6.7 versus 9.5 mo, P = 0.0582). CONCLUSION Treatment bias was demonstrated regarding resection and second-line therapies. However, bias and imbalances were controllable in the cohorts available from the 5-aminolevulinic acid study so that the present data now provide Level 2b evidence (Oxford Centre for Evidence-based Medicine) that survival depends on complete resection of enhancing tumor in glioblastoma multiforme.

Craniofacial approaches to large juvenile angiofibromas

2011 ◽  
Vol 8 (1) ◽  
pp. 71-78 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Maziyar A. Kalani ◽  
Samuel Kalb ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Average Duration ◽  
Karnofsky Performance Scale ◽  
Preoperative Embolization ◽  
Large Juvenile ◽  
Csf Leakage ◽  
Scale Scores ◽  
Duration Of Hospitalization ◽  
Performance Scale ◽  
Related Mortality

Object Craniofacial approaches provide excellent exposure to lesions in the anterior and middle cranial fossae. The authors review their experience with craniofacial approaches for resection of large juvenile nasopharyngeal angiofibromas. Methods Between 1992 and 2009, 22 patients (all male, mean age 15 years, range 9–27 years) underwent 30 procedures. These cases were reviewed retrospectively. Results Gross-total resection of 17 (77%) of the 22 lesions was achieved. The average duration of hospitalization was 8.2 days (range 3–20 days). The rate of recurrence and/or progression was 4 (18%) of 22, with recurrences occurring a mean of 21 months after the first resection. All patients underwent preoperative embolization. Nine patients (41%) developed complications, the most common of which was CSF leakage (23%). The average follow-up was 27.7 months (range 2–144 months). The surgery-related mortality rate was 0%. Based on their mean preoperative (90) and postoperative (90) Karnofsky Performance Scale scores, 100% of patients improved or remained the same. Conclusions The authors' experience shows that craniofacial approaches provide an excellent avenue for the resection of large juvenile nasopharyngeal angiofibromas, with acceptable rates of morbidity and no deaths.

Current Surgical Outcomes for Cranial Base Chordomas

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. 1355-1360 ◽  
Author(s):  
Salvatore Di Maio ◽  
Robert Rostomily ◽  
Laligam N. Sekhar
Keyword(s):  
Skull Base ◽  
Surgical Resection ◽  
Cranial Base ◽  
Controlled Study ◽  
Karnofsky Performance Scale ◽  
Free Survival ◽  
Entire Cohort ◽  
Significant Difference ◽  
Performance Scale

Abstract BACKGROUND: Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. OBJECTIVE: To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. METHODS: From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. RESULTS: Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). CONCLUSION: Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS.

Phase II study of nimustine, carboplatin, vincristine, and interferon-β with radiotherapy for glioblastoma multiforme: experience of the Kyoto Neuro-Oncology Group

2006 ◽  
Vol 105 (3) ◽  
pp. 385-391 ◽  
Author(s):  
Tomokazu Aoki ◽  
Jun A. Takahashi ◽  
Tetsuya Ueba ◽  
Natsuo Oya ◽  
Masahiro Hiraoka ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Phase Ii ◽  
Median Duration ◽  
Phase Ii Study ◽  
Progression Free Survival ◽  
Karnofsky Performance Scale ◽  
Interferon Β ◽  
Free Survival ◽  
Scale Scores ◽  
Grade 3

Object This Phase II study was performed to determine the safety, tolerability, and efficacy of combining nimustine (ACNU)–carboplatin-vincristine-Interferon-β (IFNβ) chemotherapy. Methods Ninety-seven patients with Karnofsky Performance Scale scores of 50 or greater were enrolled in the study. Nimustine (60 mg/m2), carboplatin (110 mg/m2), vincristine (0.6 mg/m2), and IFNβ (10 μg) were administered on Day 1 concomitant with radiotherapy (63 Gy); vincristine (0.6 mg/m2) and IFNβ (10 μg) on Days 8 and 15; and IFNβ alone (10 μg) three times per week throughout the course of radiotherapy. Fifty-six days after radiotherapy ended, the time schedule for chemotherapy was reset and ACNU, carboplatin, vincristine, and IFNβ were again administered on the new Day 1 and vincristine and IFNβ on the new Days 8 and 15. This course was repeated every 56 days. Instances of nonhematological toxicity were rare and mild. During the course of radiotherapy, the percentages of patients who experienced Grade 3 toxicity were 14% with neurocytopenia and 7% with thrombocytopenia. Seven percent of all adjuvant chemotherapy cycles following radiotherapy were associated with Grade 3 toxicity, as manifested in neurocytopenia or thrombocytopenia. No instance of Grade 4 toxicity was observed. The median duration of progression-free survival was 10 months (95% confidence interval [CI] 8–12 months) and the median duration of overall survival was 16 months (95% CI 13–20 months). Conclusions The combination of ACNU-carboplatin-vincristine-IFNβ chemotherapy and radiotherapy is safe and well tolerated, and may prolong survival in patients with glioblastoma multiforme.

ASSOCIATION OF SURGICALLY ACQUIRED MOTOR AND LANGUAGE DEFICITS ON OVERALL SURVIVAL AFTER RESECTION OF GLIOBLASTOMA MULTIFORME

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 463-470 ◽  
Author(s):  
Matthew J. McGirt ◽  
Debraj Mukherjee ◽  
Kaisorn L. Chaichana ◽  
Khoi D. Than ◽  
Jon D. Weingart ◽  
...  
Keyword(s):  
Overall Survival ◽  
Glioblastoma Multiforme ◽  
Extent Of Resection ◽  
Motor Deficits ◽  
Karnofsky Performance Scale ◽  
Language Deficits ◽  
Surgically Induced ◽  
Karnofsky Performance Scale Score ◽  
Performance Scale ◽  
New Onset

Abstract OBJECTIVE Balancing the benefits of extensive tumor resection with the consequence of potential postoperative deficits remains a challenge in malignant astrocytoma surgery. Although studies have suggested that increasing extent of resection may benefit survival, the effect of new postoperative deficits on survival remains unclear. We set out to determine whether new-onset postoperative motor or speech deficits were associated with survival in our institutional experience with glioblastoma multiforme (GBM). METHODS We retrospectively reviewed records of all patients (age range, 18–70 years; Karnofsky Performance Scale score, 80–100) who had undergone GBM resection between 1996 and 2006 at a single institution. Survival was compared between patients who had experienced surgically acquired motor or language deficits versus those who did not experience these deficits. RESULTS Three hundred six consecutive patients (age, 54 ± 11 years; median Karnofsky Performance Scale score, 80) underwent primary GBM resection. Nineteen patients (6%) developed surgically acquired motor deficits and 15 (5%) developed surgically acquired language deficits. Median survival was decreased in patients who acquired language deficits (9.6 months; P < 0.05) or motor deficits (9.0 months; P < 0.05) versus patients without surgically acquired deficits (12.8 months). Two-year survival was 8% and 0% for patients with surgically acquired motor or language deficits, respectively, versus 23% for patients without new-onset deficits. CONCLUSION In our experience, the development of new perioperative motor or language deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. Although it is well known that surgically induced neurological deficits affect quality of life, our results suggest that these surgical morbidities may also affect survival. Care should be taken to avoid surgically induced deficits in the management of GBM.

Treatment outcomes for patients with glioblastoma multiforme and a low Karnofsky Performance Scale score on presentation to a tertiary care institution

2011 ◽  
Vol 115 (2) ◽  
pp. 220-229 ◽  
Author(s):  
Ovidiu Marina ◽  
John H. Suh ◽  
Chandana A. Reddy ◽  
Gene H. Barnett ◽  
Michael A. Vogelbaum ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Glioblastoma Multiforme ◽  
Median Survival ◽  
Tertiary Care ◽  
Radiation Therapy Oncology Group ◽  
Tumor Resection ◽  
Karnofsky Performance Scale ◽  
Care Institution ◽  
Tertiary Care Institution ◽  
Performance Scale

Object The object of this study was to determine the benefit of surgery, radiation, and chemotherapy for patients with glioblastoma multiforme (GBM) and a low Karnofsky Performance Scale (KPS) score. Methods The authors retrospectively evaluated the records of patients who underwent primary treatment for pathologically confirmed GBM and with a KPS score ≤ 50 on initial evaluation for radiation therapy at a tertiary care institution between 1977 and 2006. Seventy-four patients with a median age of 69 years (range 19–88 years) and a median KPS score of 50 (range 20–50) were retrospectively grouped into the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) Classes IV (11 patients), V (15 patients), and VI (48 patients). Patients underwent biopsy (38 patients) or tumor resection (36 patients). Forty-seven patients received radiation. Nineteen patients also received chemotherapy (53% temozolomide), initiated concurrently (47%) or after radiotherapy. Results The median survival overall was 2.3 months (range 0.2–48 months). Median survival stratified by RPA Classes IV, V, and VI was 6.6, 6.6, and 1.8 months, respectively (p < 0.001, log-rank test). Median survival for patients receiving radiation (5.2 months) was greater than that for patients who declined radiation (1.6 months, p < 0.001). Patients in RPA Class VI appeared to benefit from radiotherapy only when tumor resection was also performed. The median survival from treatment initiation was greater for patients receiving chemotherapy concomitantly with radiotherapy (9.8 months) as compared with radiotherapy alone (1.7 months, p = 0.002). Of 20 patients seen for follow-up in the clinic at a median of 48 days (range 24–196 days) following radiotherapy, 70% were noted to have an improvement in the KPS score of between 10 and 30 points from the baseline score. On multivariate analysis, only RPA class (p = 0.01), resection (HR = 0.37, p = 0.001), and radiation therapy (HR = 0.39, p = 0.02) were significant predictors of a decreased mortality rate. Conclusions Patients with a KPS score ≤ 50 appear to have increased survival and functional status following tumor resection and radiation. The extent of benefit from concomitant chemotherapy is unclear. Future studies may benefit from reporting that utilizes a prognostic classification system such as the RTOG RPA class, which has been shown to be effective at separating outcomes even in patients with low performance status. Patients with GBMs and low KPS scores need to be evaluated in prospective studies to identify the extent to which different therapies improve outcomes.

Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme

1993 ◽  
Vol 78 (5) ◽  
pp. 762-766 ◽  
Author(s):  
Friedrich W. Kreth ◽  
Peter C. Warnke ◽  
Rudolf Scheremet ◽  
Christoph B. Ostertag
Keyword(s):  
Radiation Therapy ◽  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Cytoreductive Surgery ◽  
Neurological Deficits ◽  
Karnofsky Performance Scale ◽  
Treatment Variable ◽  
Content Type ◽  
Resection Group ◽  
Fine Print

✓ There has been considerable controversy over the concept of treating glioblastoma multiforme with cytoreductive surgery. Therefore, a retrospective study of cases treated between 1986 and 1991 was conducted to analyze and compare the results of stereotactic biopsy followed by radiation therapy performed in 58 patients with those of surgical resection plus radiation therapy in 57 patients. In both groups, conventionally fractionated radiation (1.7 to 2.0 Gy/day) was delivered, with a total dose of 50 to 60 Gy. Biopsy was performed only in patients with tumors judged to be inoperable. These patients carried a higher surgical risk and were in worse neurological condition than the patients in the resection group. The median survival time for the resection group was 39.5 weeks, as compared with 32 weeks for the biopsy group. This difference was not significant. The most important prognostic factor was the patient's age. The treatment variable biopsy versus resection did not reach prognostic relevance. In patients with midline shift who underwent biopsy, the Karnofsky Performance Scale score decreased in more patients during radiation therapy. The clinical status 6 weeks after surgery, however, showed no significant differences between the two groups. The comparable survival times for the two groups place doubt on the concept of treating glioblastoma multiforme with cytoreductive surgery. Presently, radiation therapy is the most effective treatment for patients with glioblastoma. There is no question that decompressive surgery followed by radiation therapy should be performed whenever necessary for severe space-occupying lesions and when it will not cause new neurological deficits.

scholarly journals 382 Resection of Gliomas Initially Deemed to be Inoperable

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 291-291
Author(s):  
Derek Southwell ◽  
Harjus Birk ◽  
Seunggu Jude Han ◽  
Mitchel S Berger
Keyword(s):  
Functional Outcomes ◽  
Brain Biopsy ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Total Resection ◽  
Scale Scores ◽  
Glioma Resection ◽  
Referring Physicians ◽  
Functional Areas ◽  
Performance Scale

Abstract INTRODUCTION Surgeons and referring physicians may, on the basis of radiologic studies alone, assume a glioma to be unresectable. Because imaging studies, including functional MRI, may not localize eloquent areas with high fidelity, this simplistic approach excludes some patients from what could be a safe resection. Intraoperative direct electrical stimulation (DES) accurately localizes functional areas, thereby enabling maximal resection of tumors. Here we describe the extent of resection and functional outcomes following resections of tumors deemed inoperable at outside hospitals. METHODS We retrospectively examined the cases of 58 adult patients who underwent glioma resection within six months of undergoing a brain biopsy of the same lesion at an outside hospital. All patients exhibited unifocal, supratentorial disease, and pre-operative Karnofsky Performance Scale scores = 70. We characterized the extent of resection and six-month functional outcomes for this population. RESULTS >Intraoperative DES mapping was performed on 96.6% of patients (56 of 58). Overall, the mean extent of resection was 87.6% ± 13.6% (range, 39.0% to 100%). Gross total resection (resection of >99% of the pre-operative tumor volume) was achieved in 29.3% of patients (17 of 58). Sub-total resection (95-99% resection) and partial resection (<95% resection) were achieved in 12.1% (7 of 58) and 58.6% of patients (34 of 58), respectively. Six months after surgery, no patient exhibited a new post-operative neurologic deficit. Most patients (87.9%, 51 of 58) were free of neurologic deficits both pre- and post-operatively. The remainder of patients exhibited either residual but stable deficits (5.2%, 3 of 58), or complete correction of pre-operative deficits (6.9%, 4 of 58). CONCLUSION The use of DES enabled maximal safe resections of gliomas deemed inoperable by referring neurosurgeons. With rare exceptions, tumor resectability cannot be determined solely by radiologic studies.

A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival

2001 ◽  
Vol 95 (2) ◽  
pp. 190-198 ◽  
Author(s):  
Michel Lacroix ◽  
Dima Abi-Said ◽  
Daryl R. Fourney ◽  
Ziya L. Gokaslan ◽  
Weiming Shi ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Mr Imaging ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Predictive Variables ◽  
Significant Survival ◽  
Performance Scale ◽  
Fine Print

Object. The extent of tumor resection that should be undertaken in patients with glioblastoma multiforme (GBM) remains controversial. The purpose of this study was to identify significant independent predictors of survival in these patients and to determine whether the extent of resection was associated with increased survival time. Methods. The authors retrospectively analyzed 416 consecutive patients with histologically proven GBM who underwent tumor resection at the authors' institution between June 1993 and June 1999. Volumetric data and other tumor characteristics identified on magnetic resonance (MR) imaging were collected prospectively. Conclusions. Five independent predictors of survival were identified: age, Karnofsky Performance Scale (KPS) score, extent of resection, and the degree of necrosis and enhancement on preoperative MR imaging studies. A significant survival advantage was associated with resection of 98% or more of the tumor volume (median survival 13 months, 95% confidence interval [CI] 11.4–14.6 months), compared with 8.8 months (95% CI 7.4–10.2 months; p < 0.0001) for resections of less than 98%. Using an outcome scale ranging from 0 to 5 based on age, KPS score, and tumor necrosis on MR imaging, we observed significantly longer survival in patients with lower scores (1–3) who underwent aggressive resections, and a trend toward slightly longer survival was found in patients with higher scores (4–5). Gross-total tumor resection is associated with longer survival in patients with GBM, especially when other predictive variables are favorable.

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