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II./4.3.: Symptoms
Clinical symptoms include focal neurological symptoms, dysfunctions of the region involved, such as palsy, disturbed speech, gait abnormality, dizziness, disturbed eyesight, etc. Epilepsy can be one of the symptoms present for the longest timespan, especially in the case of benign astrocytomas (4). Symptoms of increased intracranial pressure such as headache, nausea, vomiting, papilledema are nowadays rare due to the early diagnosis. Patient history can be years long in case of benign tumours, while symptoms of malignant tumours usually date back to a few months or weeks.
Prognostic systems have been developed based on different aspects. One of them is the classification system recommended by the Medical Research Council (MRC) in England, which takes account of the age, the clinical status as defined by the WHO/ECOG (Eastern Cooperative Oncology Group), the extent of surgical tumour removal, and the presence of seizures. Another method is the ’recursive partioning analysis’ (RPA), which is based on age, histological tumour type, Karnofski status (KPS), mental or neurological status, extent of tumour removal and radiation dosage. GBM patients have been assorted during their tamzolomide chemo-irradiation based on the RPA (described later). A significant difference was found in the mean and 2-year-long survival rate between the RPA III, IV and V groups. In a more simple classification system based on the neurological status better prognosis groups include patients younger than 50, who are self-sufficient or semi self-sufficient or patients older than 50, who are completely self-sufficient. The group associated with bad prognosis involves patients younger than 50 and not able to take care of themselves and patients older than 50 years old, who are semi self-sufficient.
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