|
|
Role
of early radiotherapy in the treatment of supratentorial WHO Grade II
astrocytomas: long-term results of 97 patients
Hanzely Z, Polgar C, Fodor J, Brucher JM, Vitanovics D, Mangel LC, Afra D
Department of Neuropathology, National Institute of Neurosurgery,
Budapest, Hungary.
neuropath@medscape.com
Object. To determine principal prognostic factors and the effect of
timing of radiotherapy (RT) on disease-specific survival (DSS) and
progression-free survival (PFS) in WHO Grade II astrocytomas.
Methods.
Histologic slides of 166 consecutive patients with the original tissue diagnosis
of low-grade, non-pilocytic astrocytoma were reviewed.
One-hundred and six were selected where two additional certified
neuropathologist agreed on the grading of WHO Grade II astrocytoma.
In 97 out of 106 cases follow-up informations were available.
Early postoperative RT was given to 36 out of 97 patients (37%).
The two groups of patients (early vs. delayed RT) were well balanced in respect
to extent of surgery and other main clinical prognostic factors.
Median follow-up of surviving patients was 79 months.
The 5- and 10-year PFS was 52.2% and 30.7% with early RT and 39.5% and 12.4%
with delayed RT (p = 0.0388).
In respect to DSS, there was no significant difference in the 5- and 10-year
actuarial survival rate according to the timing of RT (60.5% and 26.5% vs. 66.6%
and 23.7%; p = 0.7545).
Age (p = 0.0145) and extent of surgery (p = 0.0473) were significant prognostic
variables in respect to DSS.
Subdividing the irradiated group based on the extent of surgery, early RT in the
subtotal group significantly improved 5-year PFS (60.0% vs. 12.4%; p = 0.0036)
and DSS (66.7% vs. 49.8%; p = 0.0389).
However, postoperative RT had no influence on PFS (p = 0.6812) and DSS (p =
0.3987) in the group with extensive resection.
Conclusion.
Early postoperative RT in subtotally resected, Grade II astrocytomas
significantly improves both progression-free and disease-specific survival.
Early RT does not benefit patients with extensive resection, RT should be
withheld in these patients until progression.
PMID: 12892238 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12892238&dopt=Abstract |
