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Long-term Glioblastoma Multiforme Survivors: a Population-based Study

Published online by Cambridge University Press:  18 September 2015

J.N. Scott ,
N.B. Rewcastle ,
P.M.A. Brasher ,
D. Fulton ,
N.A. Hagen ,
J.A. MacKinnon ,
G. Sutherland ,
J.G. Cairncross  and
P. Forsyth
J.N. Scott
Affiliation:
Departments of Clinical Neurosciences and Pediatrics, The University of Calgary, and Department of Medicine, Foothills Hospital and Tom Baker Cancer Centre (TBCC), Calgary
N.B. Rewcastle
Affiliation:
Department of Pathology and Clinical Neurosciences, The University of Calgary, and Department of Medicine, Foothills Hospital, Calgary
P.M.A. Brasher
Affiliation:
Department of Epidemiology, Prevention and Screening, Alberta Cancer Board and Community Health Sciences, The University of Calgary, Calgary
D. Fulton
Affiliation:
Department of Radiation Oncology, Cross Cancer Institute (CCI) and Department of Medicine/Neurology, University of Alberta, Edmonton
N.A. Hagen
Affiliation:
Departments of Clinical Neurosciences and Pediatrics, The University of Calgary, and Department of Medicine, Foothills Hospital and Tom Baker Cancer Centre (TBCC), Calgary
J.A. MacKinnon
Affiliation:
Department of Radiation Oncology, Tom Baker Cancer Centre (TBCC), The University of Calgary, Calgary
G. Sutherland
Affiliation:
Departments of Clinical Neurosciences and Pediatrics, The University of Calgary, and Department of Medicine, Foothills Hospital and Tom Baker Cancer Centre (TBCC), Calgary
J.G. Cairncross
Affiliation:
Departments of Clinical Neurological Sciences and Oncology, Western Ontario and London Regional Cancer Centre, London, Ontario
P. Forsyth*
Affiliation:
Departments of Clinical Neurosciences and Pediatrics, The University of Calgary, and Department of Medicine, Foothills Hospital and Tom Baker Cancer Centre (TBCC), Calgary
*
Department of Medicine, Tom Baker Cancer Centre, 1331 - 29 Street N.W., Calgary, Alberta, Canada T2N 4N2
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Abstract:

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Background:

Long-term glioblastoma multiforme survivors (LTGBMS) are uncommon. The frequency which these occur in an unselected population and factors which produce these unusually long survivors are unknown.

Objectives:

To determine in a population- based study 1) the frequency of LTGBMS in a population and 2) identify which patient, treatment or tumor characteristics would predict which glioblastoma (GBM) patient would become a LTGBMS.

Methods:

The Alberta Cancer Registry was used to identify all patients diagnosed with GBM in southern Alberta between 1/1/75 - 12/31/91. Patient charts were reviewed and histology re-examined by a blinded neuropathologist. LTGBMS were defined as GBM patients surviving ≥ 3 years after diagnosis. Each LTGBMS was compared to three age-, gender-, and year of diagnosis-matched controls to compare patient, treatment, and tumor factors to GBM patients without long-term survival.

Results:

There were 279 GBMs diagnosed in the study period. Five (1.8%) survived ≥ three years (range, 3.2-15.8 years). Seven additional long-term survivors, who carried a diagnosis of GBM, were excluded after neuropathologic review; the most common revised diagnosis was malignant oligodendroglioma. LTGBMS (avg. age = 45 years) were significantly younger when compared to all GBM patients (avg. age = 59 years, p - 0.0001) diagnosed in the study period. LTGBMS had a higher KPS at diagnosis (p = 0.001) compared to controls. Tumors from LTGBMS tended to have fewer mitoses and a lower Ki-67 cellular proliferative index compared to controls. Radiation-induced dementia was common and disabling in LTGBMS.

Conclusions:

These data highlight the dismal prognosis for GBM patients who have both a short median survival and very small chance (1.8%) of long-term survival. The LTGBMS were younger, had a higher performance status, and their tumors tended to proliferate less rapidly than control GBM patients. When long-term survival does occur it is often accompanied by severe treatment-induced dementia.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 3 , August 1998 , pp. 197 - 201
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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