RadiationOncoiogy ??Biology ??Physics ARS63rdAnnualMeeting

arterial 5-Fluorouracil is excellent palliative treatment of patients pre- senting with symptomatic liver metastases. Transcient subclinical liver toxicity occurs which does not reflect a tumor resoonse. Serial olasma CEA

5:

monitoring is

(51)

RESULTS OF

the most sensitive indicator of tumor'response. ’

GLIOBLASTOMA MULTIFORME: COMBINED MODALITY TREATMENT IN ONE-HUNDRED SIX PATIENTS

Jay S. Cooper, M.D?, Thomas L. Borok, M.D. and Richard Carella, M.D.

Division of Radiation Oncology New York University Medical Center

New York, N.Y. 10016

:n recent years combined modality therapy has been employed whenever possible for the treatment of high grade brain tumors at New York Univer- sity Medical Center. Between 1973 and 1979, one-hundred six patients who had histologically proven glioblastoma multiforme, uniformly were treated by a planned course of maximum surgery consistant with maintaining neurologfc function followed by 6,000 rad whole brain irradiation. In later years, chemotherapy was added to this regimen. Overall, approxi- mately 75% of patients survived 6 months, 50% survived 1 year and 7% survived 5 years. Within the group, however, detailed analysis identifies specific factors which appear to influence outcome such as patient age at the time of diagnosis, initial signs or symptoms of disease, dominant signs or symptoms of disease, initial functional status, extent of surgery, precise degree of histologic anaplasia and the use of chemotherapy.

Combined modality therapy of glioblastoma multifowne is well tolerated and in our hands has prolonged the average lifespan of patients beyond one year.

(52) PROGNOSTIC FACTORS IN GLTOBLASTOMA MULTIFORME

1 *Harvey Gilbert , A. Robert Kagan 1 , Frank Cassidy 3 , Sherwood Davidson 2 ,

Kaspar Fuchs2, David Fox4, Deanne Gilbert2, Alan Forsythe5, David Eder2, John Wagner2, Frank Latino3, Lee Youkeless, Paul Chanl, Brace Hintzl.

Departments of Radio:herapy', Neuro-oncology2, Internal Medicine3, Mental Health4, at Southern California Permanente Medical Group, Los Angeles,

California 90027, 3Department of Biomathematics, University of California, Los Angeles, California 90024

Our Brain Tumor .3tudy Group has studied all our patients with the diagnosis . of glioblastoma multiforme. Approximately 60% of patients were treated with a multidrug chemotherapy and delayed split-course radiation therapy treatment reg- imen. 40% were felt to be better off left untreated. This selection process which was previously unknown to us was found to be comparable to that found in most community hospitals. Those patients that were treated had a median surviv- al of 10-l/2 months. Because survival is a shallow parameter in determining the quality of life in this disease, we evaluated self-care and ambulation. The probability of being out of bed and engaging in self-care depends on age and the functional level measured at ten days post-craniotomy. Age and postoperative functional status were the most predictive factors; grade, location of thelesion and preoperative functional level appeared to have weaker value in predicting survival, the ability to ambulate and engage in self-care. At 18 months post- diagnosis, only patients who were fully functional postsurgery and were lessthan 70 years of age had a reasonable chance of being ambulatory. Tables and charts will be presented to show the effect of prognostic factors on quality of lifeand survival. The effect of radiation and chemotherapy will be shown. The question of whether patients a'bove 70 years with a poor functional level postcraniotomy should be treated will be discussed.