Recursive Partitioning Analysis of Prognostic Factors in Three Radiation Therapy Oncology Group Malignant Glioma Trials

Background: Despite notable technical advances in therapy for malignant gliomas during the past decade, improved patient survival has not been clearly documented, suggesting that pretreatment prognostic factors influence outcome more than minor modifications in therapy. Age, performance status, and...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 1993-05, Vol.85 (9), p.704-710
Main Authors: Curran, Walter J., Scott, Charles B., Horton, John, Nelson, James S., Weinstein, Alan S., Fischbach, A. Jennifer, Chang, Chu H., Rotman, Marvin, Asbell, Sucha O., Krisch, Robert E., Nelson, Diane F.
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Biological and medical sciences
Brain Neoplasms - diagnosis
Brain Neoplasms - drug therapy
Female
Glioma - diagnosis
Glioma - drug therapy
Humans
Male
Medical research
Medical sciences
Middle Aged
Neurology
Prognosis
Radiation
Retrospective Studies
Statistics as Topic
Survival Analysis
Tumors
Tumors of the nervous system. Phacomatoses
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Summary:Background: Despite notable technical advances in therapy for malignant gliomas during the past decade, improved patient survival has not been clearly documented, suggesting that pretreatment prognostic factors influence outcome more than minor modifications in therapy. Age, performance status, and tumor histopathol-ogy have been identified as the pretreatment variables most predictive of survival outcome. However, an analysis of the association of survival with both pretreatment characteristics and treatment-related variables is necessary to assure reliable evaluation of new approaches for treatment of malignant glioma. Purpose: This study of malignant glioma patients used a non-parametric statistical technique to examine the associations of both pretreatment patient and tumor characteristics and treatment-related variables with survival duration. This technique was used to identify subgroups with survival rates sufficiently different to create improvements in the design and stratification of clinical trials. Methods: We used a recursive partitioning technique to analyze survival in 1578 patients entered in three Radiation Therapy Oncology Group malignant glioma trials from 1974 to 1989 that used several radiation therapy (RT) regimens with and without chemotherapy or a radiation sensitizer. This approach creates a regression tree according to prognostic variables that classifies patients into homogeneous subsets by survival. Twenty-six pretreatment characteristics and six treatment-related variables were analyzed. Results: The most significant split occurred by age (
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/85.9.704