Whittle I R, Denholm S W, Gregor A
Department of Clinical Neuroscience, Western General Hospital, Edinburgh, Scotland.
Surg Neurol. 1991 Aug;36(2):106-11. doi: 10.1016/0090-3019(91)90227-z.
This audit of clinical management confirmed the poor prognosis for patients (n = 80) aged over 60 years with a diagnosis of supratentorial glioma. The median survival time after diagnosis was 9 weeks following steroids and 7 weeks after biopsy and steroids. Cytoreductive surgery and radiotherapy improved median survival time by a maximum of 16 weeks, but there was significant morbidity in some patients undergoing craniotomy. Although 92% of the biopsied lesions were either glioblastoma or anaplastic astrocytoma, the median survival of these patients was similar to the 8% of patients confirmed as having intermediate grade astrocytoma. Patients presenting with minimal functional deficit (WHO grade I or II) had longer median survival times than those presenting in poor condition (WHO grade III or IV). In this series there was no relationship between management undertaken and clinical status of the patient. The 9% of the cohort that survived 1 year were treated in a variety of ways. This audit, together with results from other studies, suggests that a prospective clinical trial of different management regimes in elderly patients with supratentorial gliomas is needed. Since median survival time in the most intensively treated patients will be around 6 months, treatment evaluation must consider the quality of life provided.
这项临床管理审计证实，80例年龄超过60岁、诊断为幕上胶质瘤的患者预后较差。诊断后的中位生存时间在使用类固醇后为9周，活检及使用类固醇后为7周。肿瘤细胞减灭术和放疗最多可将中位生存时间延长16周，但部分接受开颅手术的患者出现了明显的并发症。尽管92%的活检病变为胶质母细胞瘤或间变性星形细胞瘤，但这些患者的中位生存时间与确诊为间变性星形细胞瘤的8%患者相似。功能缺损最小（世界卫生组织I级或II级）的患者中位生存时间长于病情较差（世界卫生组织III级或IV级）的患者。在该系列研究中，所采取的治疗措施与患者的临床状况之间没有关联。该队列中9%存活1年的患者接受了多种治疗方式。这项审计以及其他研究结果表明，需要针对老年幕上胶质瘤患者开展不同治疗方案的前瞻性临床试验。由于接受最强化治疗的患者中位生存时间约为6个月，治疗评估必须考虑所提供的生活质量。
