Prognostic value of tumour volume in patients with a poor Karnofsky performance status scale – a bicentric retrospective study

Backround Median overall survival (OS) after diagnosis of glioblastoma (GBM) remains 15 months amongst patients receiving aggressive surgical resection, chemotherapy and irradiation. Treatment of patients with a poor preoperative Karnofsky Performance Status Scale (KPSS) is still controversial. Therefore, we retrospectively assessed the outcome after surgical treatment in patients with a KPSS of ≤60%. Methods We retrospectively included patients with a de-novo glioblastoma WHO °IV and preoperative KPSS ≤60%, who underwent surgery at two neurosurgical centres between September 2006 and March 2016. We recorded pre- and postoperative tumour volume, pre- and postoperative KPSS, OS, age and MGMT promoter status. Results One hundred twenty-three patients (58 females/65 males, mean age 67.4 ± 13.4 years) met the inclusion criteria. Seventy-five of the 123 patients (61%) underwent surgical resection. 48/123 patients (39%) received a biopsy. The median preoperative and postoperative tumour volume of all patients was 33.0 ± 31.3 cm3 (IR 15.0–56.5cm3) and 3.1 ± 23.8 cm3 (IR 0.2–15.0 cm3), respectively. The median KPSS was 60% (range 20–60%) preoperatively and 50% (range 0–80%) postoperatively. Patients who received a biopsy showed a median OS for patients who received a biopsy only was 3.0 months (95% CI 2.0–4.0 months), compared to patients who had a resection and had a median OS of 8 months (95% CI 3.1–12.9 months). Age (p < 0.001, HR: 1.045 [95% CI 1.022–1.068]), postoperative tumour volume (p = 0.02, HR: 1.016 [95% CI 1.002–1.029]) and MGMT promotor status (p = 0.016, HR: 0.473 [95% CI 0.257–0.871]) were statistically significant in multivariate analysis. In subgroup analyses only age was shown as a significant prognostic factor in multivariate analyses for patients receiving surgery (p < 0.001, HR: 1.046 [95% CI 1.022–1.072]). In the biopsy group no significant prognostic factors were shown in multivariate analysis. Conclusion GBM patients with a preoperative KPSS of ≤60% might profit from surgical reduction of tumour burden.

Do Patients with a Poor Karnofsky Performance Status Scale Profit from Tumour Volume Reduction?

Purpose: Median overall survival (OS) after diagnosis of glioblastoma (GBM) remains 15 months amongst patients receiving aggressive surgical resection, chemotherapy and irradiation. Treatment of patients with a poor preoperative Karnofsky Performance Status Scale (KPSS) is still controversial. Therefore, we retrospectively assessed the outcome after surgical treatment in patients with a KPSS of ≤ 60%.Methods: We retrospectively included patients with a de-novo glioblastoma WHO °IV and preoperative KPSS ≤ 60%, who underwent surgery at two neurosurgical centres between September 2006 and March 2016. We recorded pre- and postoperative tumour volume, pre- and postoperative KPSS, OS, age and MGMT promoter status.Results: 123 patients (58 females/65 males, mean age 67.4 ± 13.4 years) met the inclusion criteria. 75 of the 123 patients (61%) underwent surgical resection. 48/123 patients (39%) received a biopsy. The median preoperative and postoperative tumour volume of all patients was 33.0 ± 31.3 cm3 (IR 15.0–56.5cm3) and 3.1 ± 23.8 cm3 (IR 0.2–15.0 cm3), respectively. The median KPSS was 60% (range 20–60%) preoperatively and 50% (range 0–80%) postoperatively. The median OS was 123 ± 220 days (IR 52–395 days). Age (p<0.001, HR: 1.045 [95% CI 1.022–1.068]), postoperative tumour volume (p=0.02, HR: 1.016 [95% CI 1.002–1.029]) and MGMT promotor status (p=0.016, HR: 0.473 [95% CI 0.257–0.871]) were statistically significant in multivariate analysis.Conclusion: Patients with a preoperative KPSS of ≤ 60% benefit from low postoperative residual tumour volumes. Age and MGMT-methylation status were also significant prognostic parameters in this patient cohort.

Gliomatose Cerebral: Caso Clínico e Revisão da Literatura

Relatamos o caso de um doente com diagnóstico de gliomatose cerebral que após dois quadros de hipertensão intracraniana grave, iniciou quimioterapia paliativa e evoluiu de forma clínica e imagiologicamente satisfatória. Doente de 33 anos de idade, previamente autónomo (Karnofsky Performance Status Scale de 100 pontos) e sem antecedentes pessoais/familiares relevantes. É investigado com tomografia computorizada e ressonância magnética cerebral no contexto de crise convulsiva inaugural. É detetada uma lesão infiltrativa fronto-parietal direita com extensão parietal contralateral através do esplénio do corpo caloso. Foi submetido a biópsia lesional por neuronavegação com diagnóstico histológico de astrocitoma grau II (OMS). Perante a integração imagiológica e anatomopatológica define-se então um processo de gliomatose cerebral. Após alta hospitalar recorre por duas vezes ao serviço de urgência com quadro de hipertensão intracraniana grave, uma das quais em estado de coma e com anisocoria pupilar.Após internamento e corticoterapia endovenosa em altas doses, recupera neurologicamente para o seu estado basal. Vinte e sete meses após o diagnóstico, encontra-se assintomático, sem défices neurológicos focais e com estabilidade imagiológica da lesão tumoral. A gliomatose cerebral é uma neoplasia rara, de apresentação clínica variável e com um diagnóstico baseado nas características imagiológicas e histológicas. Após o início dos tratamentos complementares, nomeadamente quimioterapia, poderá ser possível uma estabilização clínica e imagiológica prolongada. Recebido: 10/10/2016 - Aceite: 05/09/2017