Acute Neurological Toxicity Tied to Overall Survival

Association seen between acute and late neurological toxicity in patients with gliomas

THURSDAY, April 28 (HealthDay News) -- Acute neurological toxicities (NTs) are significantly associated with late NT and overall survival in patients with high-grade gliomas treated with surgery and chemoradiation, according to a study published online April 12 in the British Journal of Cancer.

Yaacov R. Lawrence, M.B.B.S., M.R.C.P., from the Bodine Cancer Center in Philadelphia, and colleagues evaluated the risk factors and implications of neurological side effects for patients with high-grade gliomas who underwent surgical treatment followed by chemoradiation. Acute and late grade 3 or higher NTs were analyzed in 14 Radiation Therapy Oncology Group trials comprising 2,610 patients between 1983 and 2003. Patients were treated with a systemic agent (83 percent chemotherapy, 17 percent biologic agents) during radiation. The average radiation dose was 60 Gy. The correlation between acute and late toxicity was assessed, and the association between the occurrence of acute NT and survival was measured.

The investigators identified 182 acute and 83 late NT events. Univariate analysis identified a correlation between older age, poor performance status, aggressive surgery, pre-existing neurological dysfunction, poor mental status, and twice-daily radiation and increased acute NT. Acute NT occurrence was significantly correlated with late NT (odds ratio, 2.40) and predicted worse overall survival, independent of recursive partitioning analysis class.

"We have elucidated the risk factors for NT amongst patients with high-grade glioma undergoing radiation therapy. These should be considered when designing eligibility criteria for clinical trials," the authors write.

One of the study authors disclosed financial relationships with the pharmaceutical industry.

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