{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T20:33:03Z","timestamp":1766521983495,"version":"3.48.0"},"reference-count":31,"publisher":"BMJ","issue":"7071","license":[{"start":{"date-parts":[[1996,12,14]],"date-time":"1996-12-14T00:00:00Z","timestamp":850521600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[1996,10,9]]},"published-print":{"date-parts":[[1996,12,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective<\/jats:bold>\n                    : To describe survival, disability, and morbidity after radiotherapy for malignant glioma.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design<\/jats:bold>\n                    : Two year prospective study with home interviews with patients and relatives.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting<\/jats:bold>\n                    : Seven neurosurgical and radiotherapy centres in London.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Subjects<\/jats:bold>\n                    : 105 patients aged 21 to 75: 59 had biopsy; 46 had partial macroscopic resection; 92 received radiotherapy; and 13 received steroids alone.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures<\/jats:bold>\n                    : Survival, time free from disability, and changes in disability after treatment.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Six and 12 month survival for radiotherapy patients was 70% and 39%, respectively. Age, World Health Organisation clinical performance status, extent of surgery, and history of seizures before diagnosis each influenced survival. The Medical Research Council prognostic index was also significantly related to survival. Multivariate analysis showed that initial clinical performance status was the most important component of the index. Most (80%; 49\/61) patients with a clinical performance status of 0, 1, or 2 lived at least six months before becoming permanently disabled. Most patients who had initially had a good clinical performance status (0\u20132) and who were alive six months after radiotherapy (68%; 36\/52), however, had experienced either clinical deterioration or severe tiredness after treatment. In 17% (9\/52) of these some permanent loss of function remained. These adverse effects were associated with increasing radiotherapy dose. Severely disabled patients (clinical performance status 3 or 4) gained little benefit.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion<\/jats:bold>\n                    : Severely disabled patients gain little physical benefit from radiotherapy, whereas those not so disabled may experience considerable adverse effects.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:boxed-text position=\"float\">\n                      <jats:sec>\n                        <jats:title>Key messages<\/jats:title>\n                        <jats:list list-type=\"bullet\">\n                          <jats:list-item>\n                            <jats:p>Activity of daily living checklists are useful in deciding on patients' initial per- formance status and in monitoring their progress<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>As many as one quarter of non-disabled patients may experience clinical dete- rioration and a further 42% experience considerable tiredness after radiotherapy<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>Techniques that spare normal brain from radiation should be considered<\/jats:p>\n                          <\/jats:list-item>\n                        <\/jats:list>\n                      <\/jats:sec>\n                    <\/jats:boxed-text>\n                  <\/jats:p>","DOI":"10.1136\/bmj.313.7071.1507","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T19:44:18Z","timestamp":1319744658000},"page":"1507-1512","source":"Crossref","is-referenced-by-count":46,"title":["Malignant cerebral glioma\u2014I: Survival, disability, and morbidity after radiotherapy"],"prefix":"10.1136","volume":"313","author":[{"given":"Elizabeth","family":"Davies","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Hopkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,12,14]]},"reference":[{"key":"2025122312285493000_313.7071.1507.1","unstructured":"McKeran RO Thomas DGT . The clinical study of gliomas. In: Brain tumours: scientific basis, clinical investigation and current therapy. In: Thomas DGT Graham DI eds. London: Butterworths, 1980:194\u00e2\u0080\u0093230."},{"key":"2025122312285493000_313.7071.1507.2","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S0140-6736(87)90244-3","article-title":"What follows the diagnosis by computed tomography of solitary brain tumour? Audit of one year's experience in south east Scotland","volume":"i","author":"Todd","year":"1987","journal-title":"Lancet"},{"key":"2025122312285493000_313.7071.1507.3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3109\/02688698909002810","article-title":"Experience in 300 cases of CT-guided stereotactic surgery for lesion biopsy and aspiration of haematoma","volume":"3","author":"Thomas","year":"1984","journal-title":"Br J Neurosurg"},{"key":"2025122312285493000_313.7071.1507.4","doi-asserted-by":"crossref","first-page":"333","DOI":"10.3171\/jns.1978.49.3.0333","article-title":"Evaluation of BCNU and\/or radiotherapy in the treatment of anaplastic gliomas: a co-operative clinical trial","volume":"49","author":"Walker","year":"1978","journal-title":"J Neurosurg"},{"key":"2025122312285493000_313.7071.1507.5","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1056\/NEJM198012043032303","article-title":"Randomised comparisons of radiotherapy and nitrosureas for the treatment of malignant glioma after surgery","volume":"303","author":"Walker","year":"1980","journal-title":"N Engl J Med"},{"key":"2025122312285493000_313.7071.1507.6","first-page":"121","article-title":"Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma","volume":"67","author":"Green","year":"1983","journal-title":"Cancer Treat Rep"},{"key":"2025122312285493000_313.7071.1507.7","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1136\/jnnp.46.5.460","article-title":"Morbidity in patients with intracranial gliomas","volume":"46","author":"Gibberd","year":"1983","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2025122312285493000_313.7071.1507.8","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1136\/bmj.293.6553.1015","article-title":"Differences between neurological and neurosurgical approaches in the management of malignant brain tumours","volume":"293","author":"Wroe","year":"1986","journal-title":"BMJ"},{"key":"2025122312285493000_313.7071.1507.9","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/82.6.531"},{"key":"2025122312285493000_313.7071.1507.10","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.301.6753.629","article-title":"Steps towards cost-benefit analysis of regional neurosurgical care","volume":"301","author":"Pickard","year":"1990","journal-title":"BMJ"},{"key":"2025122312285493000_313.7071.1507.11","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.307.6909.924","article-title":"Economic evaluation and health care: cost-benefit analysis","volume":"307","author":"Robinson","year":"1993","journal-title":"BMJ"},{"key":"2025122312285493000_313.7071.1507.12","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1136\/bmj.313.7071.1512","article-title":"Malignant cerebral glioma. II. Patient and relative perspectives on the value of radiotherapy","volume":"313","author":"Davies","year":"1996","journal-title":"BMJ"},{"key":"2025122312285493000_313.7071.1507.13","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19881115)62:10<2152::AID-CNCR2820621015>3.0.CO;2-T"},{"key":"2025122312285493000_313.7071.1507.14","first-page":"61","article-title":"Functional evaluation: the Barthel index","volume":"14","author":"Mahoney","year":"1965","journal-title":"MD Med J"},{"key":"2025122312285493000_313.7071.1507.15","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/026921558700100409","article-title":"An extended activities of daily living","volume":"1","author":"Nouri","year":"1987","journal-title":"Clin Rehabil"},{"key":"2025122312285493000_313.7071.1507.16","unstructured":"Royal College of Physicians . Standardised assessment scales for the elderly. London: Royal College of Physicians Publications, 1992."},{"key":"2025122312285493000_313.7071.1507.17","unstructured":"World Health Organisation . WHO handbook for reporting results of cancer treatment. Geneva: World Health Organisation, 1979."},{"key":"2025122312285493000_313.7071.1507.18","doi-asserted-by":"publisher","DOI":"10.1007\/BF00167068"},{"key":"2025122312285493000_313.7071.1507.19","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1038\/bjc.1991.396","article-title":"A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma","volume":"64","author":"Bleehen","year":"1991","journal-title":"Br J Cancer"},{"key":"2025122312285493000_313.7071.1507.20","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/0360-3016(80)90175-3","article-title":"Therapeutic irradiation and brain injury","volume":"6","author":"Sheline","year":"1980","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2025122312285493000_313.7071.1507.21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/jns.1987.66.1.0001","article-title":"Radiation therapy for neoplasms of the brain","volume":"66","author":"Leibel","year":"1987","journal-title":"J Neurosurg"},{"key":"2025122312285493000_313.7071.1507.22","unstructured":"Wara WM Larson DA . Central nervous system manifestations of radiotherapy. In: Plowman PN McElwain TJ Meadows AT eds. Complications of cancer management. London: Butterworth-Heinemann, 1991"},{"key":"2025122312285493000_313.7071.1507.23","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1136\/bmj.4.5891.523","article-title":"Somnolence after prophylactic cranial irradiation in children with acute lymphoblastic leukaemia","volume":"iv","author":"Freeman","year":"1973","journal-title":"BMJ"},{"key":"2025122312285493000_313.7071.1507.24","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/j.1365-2648.1991.tb01798.x","article-title":"Patients' experiences following cranial radiotherapy: a study of the somnolence syndrome","volume":"16","author":"Faithfull","year":"1991","journal-title":"J Adv Nurs"},{"key":"2025122312285493000_313.7071.1507.25","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19830915)52:6<997::AID-CNCR2820520612>3.0.CO;2-2"},{"key":"2025122312285493000_313.7071.1507.26","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19870501)59:9<1617::AID-CNCR2820590916>3.0.CO;2-X"},{"key":"2025122312285493000_313.7071.1507.27","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.55.4.271"},{"key":"2025122312285493000_313.7071.1507.28","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19810215)47:4<649::AID-CNCR2820470405>3.0.CO;2-W"},{"key":"2025122312285493000_313.7071.1507.29","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/0090-3019(91)90227-Z","article-title":"Management of patients aged over 60 years with supratentorial glioma: lessons from an audit","volume":"36","author":"Whittle","year":"1991","journal-title":"Surg Neurol"},{"key":"2025122312285493000_313.7071.1507.30","first-page":"689","article-title":"Radiation injury of the brain","volume":"156","author":"Valk","year":"1991","journal-title":"Am J Neuroradiol"},{"key":"2025122312285493000_313.7071.1507.31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/bjc.1989.207","article-title":"Back to the future - radiotherapy in high grade gliomas","volume":"60","author":"Brada","year":"1989","journal-title":"Br J Cancer"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.313.7071.1507","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.313.7071.1507","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T20:29:04Z","timestamp":1766521744000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.313.7071.1507"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,12,14]]},"references-count":31,"journal-issue":{"issue":"7071","published-online":{"date-parts":[[1996,12,14]]},"published-print":{"date-parts":[[1996,12,14]]}},"alternative-id":["10.1136\/bmj.313.7071.1507"],"URL":"https:\/\/doi.org\/10.1136\/bmj.313.7071.1507","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"type":"print","value":"0959-8138"},{"type":"electronic","value":"1468-5833"}],"subject":[],"published":{"date-parts":[[1996,12,14]]}}}