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Fractionated
stereotactic radiotherapy in low-grade astrocytomas: Long-term outcome and
prognostic factors
Christian
Plathow M.D.*,², Daniela Schulz-Ertner M.D.²,
Christoph Thilman M.D.*, Ivan Zuna Ph.D.*,
Mathias Lichy M.D.¹, Marc-André Weber M.D.§,
Heinz-Peter Schlemmer M.D.¹, Michael Wannenmacher M.D.² and Jürgen
Debus M.D., Ph.D.*,²
*Division of Radiation
Oncology, German Cancer Research Center, Heidelberg, Germany;
¹Division of Diagnostic Radiology, German Cancer Research Center, Heidelberg,
Germany; ²Department of Radiation Oncology, University of Heidelberg, Heidelberg,
Germany; §Department of Neurology, University of Heidelberg, Heidelberg,
Germany.
Received 24 January 2003; revised 6 May 2003; accepted 2 June 2003.
Available online 17 October 2003
Purpose.
To evaluate outcome after
fractionated stereotactic radiotherapy (RT) of patients with World Health
Organization Grade 2 astrocytoma in terms of progression-free survival, overall
survival, toxicity, quality of life, and prognostic factors.
Methods
and materials. Between 1984 and 2000, 143 patients with histologically
proven Grade 2 astrocytoma were treated with fractionated stereotactic RT at our
institution.
The evaluation of the quality of life and toxicity was based on neurologic
examinations and the Karnofsky performance score.
Univariate analysis was performed on seven potential prognosticators and
multivariate analysis on four prognosticators.
Results.
The median follow-up was 44 months.
The actuarial overall survival and progression-free survival was 58% and 39% at
5 years, respectively.
Out-of-field recurrences occurred in 1 patient (1.2%).
We did not observe a dose–response relationship.
Overall survival and progression-free survival were significantly correlated
with the absence of contrast media enhancement before RT (p
<0.01).
Toxicity was mild and included severe side effects of European Organization for
Research and Treatment of Cancer/Radiation Therapy Oncology Group Grade 3 in
only 4 patients (2.8%).
The Karnofsky performance score improved in most patients.
Conclusion.
Fractionated stereotactic RT is effective and has low toxicity in the
treatment of Grade 2 gliomas.
The rate of field border recurrences was not increased compared with after
conventional RT.
Exceeding the tumor dose did not improve the tumor control rate but did enhance
toxicity.
Pretherapeutic contrast media enhancement should be interpreted as a sign of
higher grade tumor elements.
Author
Keywords: Astrocytoma;
Stereotactic radiotherapy; Toxicity; Prognosticators
Presented in part at ASTRO 2001, San Francisco, CA (Abstract
1055); German Congress of Cancer 2002, Berlin, Germany (Abstract 406); and DEGRO 2002, Berlin, Germany (Abstract 129)
Copyright
© 2003 Elsevier Inc. All rights reserved.
Source: http://www.sciencedirect.com/science/article/B6T7X-49SW497-D/1/29c1249ac07c3445d4392652f6e7dee6
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