Neurological infections: advances in therapy, outcome, and prediction.

www.thelancet.com/neurology Vol 8 January 2009 19 as chemoradiation add to the burden of disease. In a randomised EORTC study in 386 patients with anaplastic oligodendrogliomas, the eff ect of combined procarbazine, lomustine, and vincristine (PCV) chemotherapy after radiotherapy was compared with radiotherapy. Quality of life was measured using EORTC questionnaires on quality of life and on brain cancer. During and shortly after chemotherapy, there was a major negative eff ect on quality of life due to nausea and vomiting, loss of appetite, and drowsiness. However, no long-term detrimental eff ects could be detected in patients receiving both radiotherapy and PCV chemotherapy. Thus, the benefi cial eff ects of adjuvant PCV chemotherapy on prolonging progression-free survival in patients with anaplastic oligodendrogliomas, particularly in the subset of patients with combined loss of heterozygosity on chromosome arms 1p and 19q, are not being off set by durable side-eff ects. In a study of 363 patients with low-grade or high-grade gliomas, 205 patients had depression, anxiety, or both. Patients with high-grade gliomas had signifi cantly less anxiety than did those with low-grade disease (odds ratio 0·361, 95% CI 0·203–0·641). Multivariate analysis showed that men had a 36% lower risk of depression than did women, and a history of psychiatric problems was associated with an increased risk of current depression. This study highlights the importance of attention to psychological factors and complements advances in recognition of independent prognostic factors and molecular characteristics of the tumour. Nomograms based on long follow-up data from chemoradiotherapy in glioblastoma multiforme can now help to predict the prognosis of the individual patient.