Six Factors Influence Long-Term Brain Cancer Survival

TAMPA, Fla--The average brain tumor patient survives just 1 yearafter diagnosis, so long-term survival, defined as living at least100% longer than the median survival of historical controls, isespecially remarkable. Previous studies have shown that only 7%to 10% of brain cancer patients survive long-term.

Why a small number of patients have survived for 4, 10, even 20years is not clearly understood, but a few prognostic factorsare beginning to emerge, said Surasak Phuphanich, MD, chief ofneurology services, H. Lee Moffitt Cancer Center and ResearchInstitute.

Dr. Phuphanich spoke to a group of 45 survivors, their families,and physicians at Moffitt's Brain Cancer Survivor Day luncheon(see photo).

Moffitt held the program to recognize its own patients with primarymalignant gliomas who have survived between 4.2 years and 20 years.Their ages range from 8 to 58 years (median, 33). Nine are malesand 10 are females. Many of them are working and leading normallives.

Dr. Phuphanich and his colleagues have identified six factorsthat appear to influence long-term survival.

1. Age at diagnosis. "People younger than 45 tendto do better. We don't know why, but it may be because youngerpeople have better immune system response and can tolerate treatmentbetter," he said.

2. Type of brain tumor. Patients with anaplastic astrocytomatumors tend to survive longer than those with glioblas-toma multiforme,the most deadly. Sixty percent of tumors are glioblastoma multiforme,and even patients receiving surgery, radiation, and chemotherapytypically survive for only 1 year, Dr. Phuphanich said.

Patients receiving multimodality therapy for anaplastic astrocytomahave a 4-year survival average. For patients with metastatic braintumors, Dr. Phuphanich said, survival averages only 3 months.

3. Location of the tumor in the brain. Tumors may occurin the frontal, parietal, temporal, or occipital lobes, but developmost often in the frontal (and largest) lobe, which is also themost favorable in terms of survival. "When the tumor is inthe prefrontal area of the brain, the location allows the surgeonto remove the entire tumor without its having a major impact onthe patient's functioning," Dr. Phuphanich said.

4. Patient's level of functioning. "A brain tumorpatient whose functional score is good and who does not requireassistance for daily living at the time of diagnosis and earlyin treatment typically tends to do much better than someone whostarts out, for instance, in a wheelchair," he said.

Most of Moffitt's 10-year survivors are at the 90% level on theKarnofsky Performance Scale, and are able to work or attend school,and require very little help from their family or caregivers.

5. Duration of initial symptoms when a brain tumor is diagnosed.Patients in whom seizures have occurred, for example, for longerthan 3 months seem to have a better chance of surviving long-term.This is because with a higher grade of malignant tumor, the patientusually develops symptoms of headache and seizure activity early,Dr. Phuphanich said.

6. Type of treatment. The longest surviving brain cancerpatients at the Moffitt Cancer Center received multimodality therapy:surgery, radiation, and chemotherapy. All of Moffitt's long-termsurvivors were given carmustine (BCNU or BiCNU) by IV, and somereceived carmustine in combination with other agents such as fluorouraciland pro-carbazine (Matulane). Lomustine (CCNU or CeeNU), givenorally, and vincristine were also used.

"Anaplastic tumors respond fairly well to multimodality therapy,"Dr. Phupha-nich noted. "The average survival with surgery,radiation, and PCV chemotherapy [procarbazine, CCNU, vincristine]is now 4 years. We've come a long way with this treatment regimen.It used to be just 9 months in the early 1970s."

Shelley Major, who was diagnosed with a malignant anaplastic astrocytoma10 years ago, told her fellow cancer survivors: "The onething that all of us have in common is that we refuse to acceptthe disease--which is not to be mistaken for denial. Acceptanceto me is like giving up, and none of us are willing to do that.We kept fighting and we beat it." Ms. Major is currentlyworking as an x-ray technician at a local hospital.

'You Can't Give Up'

Whether brain cancer patients who survive tumor-free for longerthan 10 years can be considered cured, Dr. Phuphanich said, isa matter of speculation. "The message to both patients andphysicians is that some people do make it, and there are manymore clinical trials with new, promising agents for the treatmentof primary brain cancer available in most major medical centersthan there were 20 years ago."

Dr. Phuphanich said that he encourages brain cancer patients toparticipate in these clinical trials in order to improve theirchances for better survival. "You don't know until you tryvarious treatments if they will work," he added. "Youcan't give up."