Early toxicity predicts long-term survival in high-grade glioma

Y. R. Lawrence, M. Wang, A. P. Dicker, D. Andrews, W. J. Curran, J. M. Michalski, L. Souhami, W. K. Yung, M. Mehta

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background:Patients with high-grade gliomas are treated with surgery followed by chemoradiation. The risk factors and implications of neurological side effects are not known.Methods:Acute and late grade 3 neurological toxicities (NTs) were analysed among 2761 patients from 14 RTOG trials accrued from 1983 to 2003. The association between acute and late toxicity was analysed using a stepwise logistic regression model. The association between the occurrence of acute NT and survival was analysed as an independent variable.Results:There were 2610 analysable patients (86% glioblastoma, 10% anaplastic astrocytoma). All received a systemic agent during radiation (83% chemotherapy, 17% biological agents). Median radiation dose was 60 Gy. There were 182 acute and 83 late NT events. On univariate analysis, older age, poor performance status, aggressive surgery, pre-existing neurological dysfunction, poor mental status and twice-daily radiation were associated with increased acute NT. In a stepwise logistic regression model the occurrence of acute NT was significantly associated with late NT (OR2.40; 95% CI1.2-4.8; P0.014). The occurrence of acute NT predicted poorer overall survival, independent of recursive partitioning analysis class (median 7.8 vs 11.8 months). Interpretation:Acute NT is significantly associated with both late NT and overall survival.

Original languageEnglish
Pages (from-to)1365-1371
Number of pages7
JournalBritish Journal of Cancer
Issue number9
StatePublished - Apr 26 2011


  • glioblastoma
  • normal tissue effects
  • radiation therapy
  • toxicity


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