Abstract
103 patients with the diagnosis of AAF were identified from the RT/BCNU arms of 3 RTOG malignant glioma trials. Pre-treatment tumor size was < 5 cm for 48% and ≥ 5 cm for 52%, and tumor sites were frontal lobe in 55%, temporal in 25%, and parietal in 16%. Surgery consisted of biopsy for 30%, partial resection for 56%, and total resection for 14%. Extent of surgery correlated with age, with 81% of patients < 40 undergoing partial/total resection vs. 60% of those over 40 (P = 0.019).
The median survival time (MST) of patients undergoing partial/total resection was 49 mo., vs. 18 mo. for those biopsied only (P = 0.002). Patients with frontal location had longer MST than those with non-frontal lesions (MST: 49 vs. 25 mo., P = 0.047), while no survival difference was apparent by univariate analysis of tumor size. Multivariate analysis demonstrated that only younger age, frontal location, and smaller tumor size correlated significantly with extended survival. Extent of surgery was not predictive.
The close correlation between young age and extensive surgery obscures the survival advantage for greater surgery seen with univariate analysis. Smaller tumor size and frontal location favorably influence outcome even when adjusted by age.
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References
Mahaley MS, Meitlin C, Natarajan N et al.: National survey of patterns of care for brain-tumor patients. J Neurosurg 71: 7-826–836, 1989
Chang CH, Horton J, Schoenfeld D et al.: Comparison of postoperative radiotherapy and chemotherapy in the multi-disciplinary management of malignant gliomas. Cancer 52: 997–1007, 1983
Nelson DF, Curran WJ, Nelson JS et al.: Hyperfractionation in malignant glioma: Report on a dose searching phase I/II protocol of the Radiation Therapy Oncology Group (RTOG). Proc Am Soc Clin Oncol 9: 90, 1990 (Abstr)
Fulton DS, Urtasun RC, Shin KH et al.: Misonidazole combined with hyperfractionation in the management of malignant glioma. Int J Radiat Oncol Biol Phys 10: 1709–1712, 1984
Leibel SA, Gutin PH, Wara WM et al.: Survival and quality of life after interstitial implantation of removable high-activity Iodine-125 sources for the treatment of patients with recurrent malignant gliomas. Int J Radiat Oncol Biol Phys 17: 1129–1139, 1989
Hildebrand J: Misonidazole in radiotherapy of supratentorial malignant brain gliomas in adult patients: A randomized double-blind study. Eur J Cancer 19: 39–42, 1983
Levin VA, Wara WM, Gutin CB et al.: Initial analysis of NCOG 6G82–1: Bromodeoxyuridine (BUdR) during irradiation followed by CCNU, procarbazine, and vincristine (PCV) chemotherapy for malignant glioma. Proc Am Soc Clin Oncol 9: 91, 1990 (Abstr)
Shapiro WR, Green SB, Burger PC et al.: Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. J Neurosurg 71: 1–9, 1989
Levin VA, Silver P, Hannigan J et al.: Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Radiat Oncol Biol Phys 18: 321–324, 1990
Rozenthal JM, Robins I, Finlay J et al.: ‘Eight-drugs-in-one-day’ chemotherapy administered before and after radiotherapy to adult patients with malignant gliomas. Cancer 63: 2475–2481, 1989
Marshall LF, Langfitt TW: Needle biopsy, high-dose corticosteroids, and radiotherapy in the treatment of malignant glial tumors. NO Monog 46: 157–160, 1977
King RB, Schell GR: Cortical localization and monitoring during cerebral operations. J Neurosurg 67: 210–219, 1987
Kelly PJ, Kall BA, Goerss S, Earnest F: Computer-assisted stereotaxic laser resection of intra-axial neoplasms. J Neurosurg 64: 427–439, 1986
Coffey RJ, Lunsford D, Taylor FH: Survival after stereotactic biopsy of malignant gliomas. Neurosurgery 22: 465–473, 1988
Nazzaro JM, Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73: 331–334, 1990
Salcman M: Surgical resection of malignant brain tumors: Who benefits? Oncol 2: 47–59, 1988
Andreou J, George AE, Wise A, de Leon M, Kricheff II, Ransohoff J, Foo S-H: CT prognostic criteria of survival after malignant glioma surgery. Am J Neurorad 4: 488–490, 1983
Vecht CJ, Avezaat CJJ, van Putten WLJ, Eijkenboom WMH, Stefanko SZ: The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis in 243 patients. J Neurol Neurosurg Psych 53: 466–471, 1990
Ciric I, Ammirati M, Vick N et al.: Supratentorial gliomas: Surgical considerations and immediate postoperative results. Gross total resection versus partial resection. Neurosurg 21: 21–26, 1987
Nelson JS, Tsukada Y, Schoenfeld D, Fulling K, Lamarche J, Peress N: Necrosis as a prognostic criterion in malignant supratentorial, astrocytic gliomas. Cancer 52: 550–554, 1983
Burger PC, Vogel S, Green SB, Strike TA: Glioblastoma multiforme and anaplastic astrocytoma: Pathologic criteria and prognostic implications. Cancer 56: 1106–1111, 1985
Nelson DF, Diener-West M, Weinstein AS et al.: A randomized comparison of misonidazole sensitized radiotherapy plus BCNU and radiotherapy plus BCNU for treatment of malignant glioma after surgery: Final report of an RTOG study. Int J Radiat Oncol Biol Phys 12: 1793–1800, 1986
Peto R, Pike MC, Armitage P et al.: Design and analysis of randomized trials required prolonged observation of each patient. II. Analysis and examples. Br J Cancer 35: 1–39, 1977
Cox DR: Regression models and life tables. J Royal Star Soc Series B 34: 187–229, 1972
Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481, 1958
Medical Research Council Brain Tumor Working Party: Prognostic factors for high-grade malignant glioma: Development of a prognostic index. J Neuro-Oncol 9: 47–55, 1990
Gehan EA, Walker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46: 189–195, 1977
Ammiriti M, Vick N, Liao Y: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurg 21: 201–206, 1987
Vick NA, Ciric IS, Eller TW et al.: Reoperation for malignant astrocytoma. Neurology 39: 430–432, 1989
Eyre HJ, Quagliana JM, Eltringham JR et al.: Randomized comparisons of radiotherapy and CCNU versus radiotherapy, CCNU plus procarbazine for the treatment of malignant gliomas following surgery. A Southwest Oncology Group report. J Neuro-Oncol 1: 171–177, 1983
Wood JR, Green SB, Shapiro WR: The prognostic importance of tumor size in malignant gliomas: A computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol 6: 338–343, 1988
Nelson DF, Nelson JS, Davis LR et al.: Survival and prognosis of patients with astrocytoma with atypical or anaplastic features. J Neuro-Oncol 3: 99–103, 1985
Shibamoto Y, Yamashita J, Takahashi M et al.: An analysis of radiation therapy in 178 cases. Radiather Oncol 18: 9–17, 1990
Jelsma R, Bucy PC: Glioblastoma multiforme. Its treatment and some factors effecting survival. Arch Neurol 20: 161–171, 1969
Brihaye J, Brochi J, Calliauw L et al.: Evaluation of CCNU, VM-26 Plus CCNU, and procarbazine in supratentorial brain gliomas: Final evaluation of a randomized study. J Neurosurg 55: 27–31, 1981
Hoshino T, Prados M, Wilson CB, Cho KG, Lee K-S, Davis RL: Prognostic implications of the bromodeoxyuridine labeling index of human gliomas. J Neurosurg 71: 335–341, 1989
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Curran, W.J., Scott, C.B., Horton, J. et al. Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report from three Radiation Therapy Oncology Group (RTOG) trials. J Neuro-Oncol 12, 219–227 (1992). https://doi.org/10.1007/BF00172709
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DOI: https://doi.org/10.1007/BF00172709