Survival of patients with glioblastoma multiforme has not improved between 1993 and 2004: analysis of 625 cases.

Glioblastoma is the most common primary brain tumour. The aim of this study was to determine trends in survival over a 12-year period. Survival data were collected retrospectively for 625 patients who had surgery for histologically-confirmed glioblastoma between 1993 and 2004 in a single centre. Data including age, sex, preoperative Karnofsky performance score, tumour site, date of surgery, and type of surgical and adjuvant treatment were collected. Overall median survival was 189 days; there was no significant change in survival over 12 years. Multivariate analysis identified the following independent positive prognostic factors: age <60 years (p < 0.0005), Karnofsky score > or = 70 (p < 0.0001), tumour debulking, rather than biopsy (p < 0.001), right-sided lesion (p < 0.05), unilateral tumour (p < 0.05) and radiotherapy (p < 0.0001). Despite neurosurgical advances, the survival of patients with glioblastoma has not changed for more than a decade. Although, overall, glioblastoma has a short survival, our data show that individual patient survival is heterogeneous.

Neuropathological diagnostic accuracy.

This study investigated variations in neuropathological diagnosis when histopathological slides are evaluated with access to all information pertinent to a case, compared with evaluation of H & E stained slides with only limited clinical information. The aim of the study is to evaluate the role of 'local' factors in reaching a definitive, neuropathological diagnosis. Each of 227 cases was reviewed by the local neuropathologist at one of three European centres with access to all clinical, radiological and histopathological data. Each case was also reviewed by a second, independent neuropathologist at another European unit, who was blinded to the local pathologist's diagnosis, and only had access to the age and sex of the patient and the location of the lesion. For the histopathological evaluation, initially he had access to H & E and GFAP stains only. Diagnoses were made using the WHO 2000 classification system and the two evaluations were classified into one of the following four categories: complete agreement; minor disagreement (not affecting treatment); minor disagreement (affecting treatment); complete disagreement. In 175 (77.1%) cases there was complete agreement between the two neuropathologists and in 18 (7.9%) cases there were non-treatment altering discrepancies in the diagnoses. Overall, there was disagreement which might potentially affect treatment in 34 (15%) of the cases. Histopathological diagnosis of the majority (85%) of brain tumours is accurate and uniform. However, histopathology is subject to a degree of interpretation. The availability of full, 'local', clinical information may be of considerable importance to the diagnostic process.

The contribution of proton magnetic resonance spectroscopy (1HMRS) to clinical brain tumour diagnosis.

Proton magnetic resonance spectroscopy (1HMRS) provides biochemical information from tissue non-invasively, and has an evolving role in brain tumour diagnosis and management. We present 100 consecutive patients with brain tumours who had single voxel 1HMRS as part of their preoperative investigations. We report the histopathological findings and the diagnostic contribution of spectroscopy in an adjunctive role. On the basis of clinical and radiological information the preoperative diagnosis was unclear or inaccurate in 26 out of 100 cases. The discrepancy was of lesion grade in 17 cases and lesion type in 9 cases. In 6 of 100 patients with brain tumours 1HMRS could have made a significant contribution to the preoperative diagnosis if used as part of the routine assessment. There is therefore a useful role for 1HMRS in the evaluation of intracranial mass lesions.