Chicago - An examination of how the most common type of primary brain tumor is treated found that care does not always follow established practice guidelines, according to a study in the February 2 issue of JAMA.
Malignant gliomas (brain tumors, grade III or IV) are the most common primary brain tumor, and their incidence is increasing over time, according to background information in the article. These tumors are the second-most common cause of cancer-related death in the young-adult age group and are associated with extensive illness. Despite intensive research, the prognosis for patients with malignant glioma remains poor. Typical survival for patients with grade III glioma is 3 to 5 years and is less than 1 year for patients with glioblastoma multiforme (grade IV glioma). Current treatment for patients with malignant glioma includes maximum safe resection (surgical removal), radiation therapy, and chemotherapy.
Susan M. Chang, M.D., of the University of California, San Francisco, and colleagues conducted a study to provide data to enable comparison of individual practice patterns and outcomes for adults with malignant glioma. The Glioma Outcomes (GO) Project enrolled 788 patients at 52 clinical sites, both academic and community practices, between December 1997 and July 2000. The enrollment criteria included adult patients with primary grade III or IV glioma undergoing a first or second operation for diagnosis or treatment. The data collection instruments included questionnaire forms given at enrollment, during the perioperative period, and at follow-up intervals of 3 months until death or a maximum of 24 months. Of the patients recorded in the GO database, 565 patients with newly diagnosed tumors were used for this analysis.
The researchers found that most patients underwent magnetic resonance imaging (n = 518; 92 percent) and an attempt at tumor resection (n = 425; 75 percent). Most received perioperative corticosteroids (n = 535; 99 percent) and antiepileptic medications (n = 497; 88 percent), but few received antidepressants (n = 38; 8 percent) or prophylactic heparin (n=42; 7 percent). Most received radiation therapy (n = 479; 87 percent) in addition to other therapy, but fewer received chemotherapy (n = 300; 54 percent). Practice patterns varied significantly between academic and community settings.
"We present patterns of care for a large group of patients with newly diagnosed malignant glioma treated in the modern era. Some common practice patterns are in keeping with published literature (e.g., use of radiation therapy), some contradict published guidelines (e.g., frequent prophylactic antiepileptic drug administration) or may conflict with published literature (e.g., relatively infrequent use of chemotherapy), and still others point out areas for further investigation in this population, including heparin prophylaxis for venous thromboembolism, antidepressant medication, corticosteroid dosing, and use of surgical adjuncts. Variations in patterns of care were associated with differences in survival; establishing further practice guidelines may help reduce this variability. One of the major benefits of the GO Project is that it provides a broad historical cohort that can be used as a comparison for future prospective studies," the authors conclude.
(JAMA. 2005;293:557-564. Available post-embargo at JAMA.com)
Editor's Note: For funding and financial disclosure information, please see the JAMA article.
