Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA.
J Neurosurg. 2011 Aug;115(2):220-9. doi: 10.3171/2011.3.JNS10495. Epub 2011 May 6.
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.
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.
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.
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.
本研究旨在确定手术、放疗和化疗对卡氏功能状态评分（KPS）较低的多形性胶质母细胞瘤（GBM）患者的获益。
作者回顾性评估了 1977 年至 2006 年间在一家三级医疗机构接受初始放疗的经病理证实的 GBM 且初始 KPS 评分≤50 的患者的记录。74 名患者的中位年龄为 69 岁（范围 19-88 岁），中位 KPS 评分为 50（范围 20-50），他们被回顾性分为放射治疗肿瘤学组（RTOG）递归分区分析（RPA）IV 类（11 例）、V 类（15 例）和 VI 类（48 例）。患者行活检（38 例）或肿瘤切除术（36 例）。47 例患者接受放疗。19 例患者还接受化疗（53%替莫唑胺），同时（47%）或放疗后开始化疗。
总体中位生存期为 2.3 个月（范围 0.2-48 个月）。按 RPA 分级 IV、V 和 VI 分层的中位生存期分别为 6.6、6.6 和 1.8 个月（p<0.001，对数秩检验）。接受放疗的患者中位生存期（5.2 个月）大于拒绝放疗的患者（1.6 个月，p<0.001）。仅当肿瘤切除术也进行时，RPA 分级 VI 类患者似乎从放疗中获益。同时接受放疗和化疗的患者的中位生存期（9.8 个月）大于单独接受放疗的患者（1.7 个月，p=0.002）。在放疗后中位 48 天（范围 24-196 天）的随访中，20 名患者中有 70%的 KPS 评分从基线评分提高了 10-30 分。多变量分析显示，仅 RPA 分级（p=0.01）、切除术（HR=0.37，p=0.001）和放疗（HR=0.39，p=0.02）是死亡率降低的显著预测因素。
KPS 评分≤50 的患者在肿瘤切除和放疗后似乎具有更高的生存率和功能状态。同期化疗的获益程度尚不清楚。未来的研究可能受益于利用 RTOG RPA 分级等预后分类系统进行报告，该系统在低表现状态患者中也显示出有效区分结果的能力。需要对 KPS 评分较低的 GBM 患者进行前瞻性研究，以确定不同治疗方法在改善预后方面的程度。
