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2089 Supratentorial low grade glioma: Results and prognostic factors following postoperative radiotherapy
Proceedings
of the 41st Annual
ASTRO
Meeting
323
retrospective study to evaluate the impact of surveillance imaging on quality of life. However, because of the lack of quality of life data and small number of patients we still recommend surveillance imaging for these patients. We think it is worthwhile to study theses issues in a prospective setting and/or with larger data bank.
2088 Marshall Dept.
BRAIN STEM UNIVERSITY DT,
Mendenhall
of Radiation
GLIOMAS: OF FLORIDA NP, Marcus,
Oncology,
University
Purpose/Objective: Retrospective review stem glioma at the University of Florida.
LONG-TERM
SURVIVAL
AND
TOXICITY
OUTCOME
AT
THE
Jr RB of Florida
College
of survival
of Medicine,
and toxicity
outcome
Gainesville, in patients
FL,
USA
treated
with radiotherapy
(RT)
for brain
Materials & Methods: All patients with brain stem gliomas treated with RT at the University of Florida from 1980 to I996 were included in this study. Patients with lesions centered in the thalamus or cerebellum were excluded. Sixty patients met these criteria. The median age was 14 years (range, 2.4 to 66.3 y). Twenty patients were (21 years and 40 patients were 221 years of age. Follow-up ranged from 2 to 18 years (median, 8.25 y). Forty-two patients received hyperfractionated RT with a median dose of 70.2 Gy and a median dose per fraction of 1.17 Gy b.i.d. Eighteen patients received standard fractionation RT with a median dose of 54 Gy and a median dose per fraction of 1.79 Gy. Histologic grade of the tumors was as follows: no tissue diagnosis, 21; low grade, 17; intermediate grade, 15; high grade, 7. Patients were classified into one of three risk groups according to duration of symptoms and description of the radiographic appearance of the lesion. Two patients could not be classified into a risk group because of lack of information in the patients’ medical records. Seventeen patients were classified as low risk, 25 as intermediate risk, and 16 as high risk. All high grade and all high risk lesions were treated with b.i.d. RT. Two patients were treated with RT a second time for recurrence. Eleven patients received RT and chemotherapy (6 with bone marrow transplantation) and two patients received cisplatin-based regimens. Results: Actuarial overall survival at 5 years was 43% (71% for patients treated q.d. and 31% for patients treated b.i.d.; p = ,012). Five-year actuarial survival by histologic grade was as follows: 38% for no tissue diagnosis, 69% for low grade, 40% for intermediate grade, and 0% for high grade (p = .0056). Survival by risk group was as follows: 0% for not classified, 82% for low risk, 44% for intermediate risk, and 0% for high risk (p = .OOOl). Five-year actuarial survival was 38% for pediatric patients and 55% for adults (p = ,610). Chemotherapy showed no benefit to survival. Multivariate analysis of risk group, fractionation scheme, and age revealed only risk group as a statistically significant prognostic factor. Twenty-four patients lived >2 years (10 adults and 14 children). One adult suffered hearing loss. No adults suffered recurrent otitis, osteoradionecrosis. or cholesteatoma formation. Children suffered from hearing loss (57%) recurrent otitis media or externa (29%), osteoradionecrosis of the temporal bone (14%), or cholesteatoma formation (14%). Osteoradionecrosis and cholesteatoma formation only occurred in pediatric patients who received hyperfractionated RT (and, thus, a higher dose). Only 24 of 60 patients were alive at the time of analysis. Of these living patients, 13 were fully functional with only mild sequelae, 9 were functional but with moderate to severe complications, and 2 were ventilator dependent (attributed to location of tumor and attempted resection). Conclusions: This retrospective study supports recent randomized trials that show no benefit to hyperfractionation (and subsequent dose escalation) in the treatment of brain stem gliomas. All patients with high grade lesions or a combination of short duration of symptoms and a diffuse, infiltrating pattern on imaging studies died. Although higher dose, hyperfractionated RT does not appear to produce more hearing loss than standard fractionation schemes, it does appear to produce serious late sequelae such as osteoradionecrosis in a small percentage of pediatric patients, a side effect not reported with standard fractionation RT.
2089 Brunner University
SUPRATENTORIAL LOW GRADE GLIOMA: RESULTS FOLLOWING POSTOPERATIVE RADIOTHERAPY TB, Grabenbauer Hospitals
GG, Roedel
Erlangen,
Eulangen,
Purpose/Objective: To assess treatment 77 patients (pts) with low-grade glioma.
CM,
Paulus
W, Buchfelder
AND
M, Schrell
PROGNOSTIC
UH, Fahlbusch
FACTORS R, Sauer R
German) outcome
and prognostic
factors
following
Materials & Methods: Between 1977 and 1996, 45 pts with astrocytoma. 14 glioma received postoperative RT with a median total dose of 52 Gy (range immediately following surgery, ten pts with tumour progression. The influence seizures, duration of symptoms ( 6 weeks vs. 6 weeks), CT pattern (enhancement RT dose, timing of RT, proliferation and apoptosis) on relapse-free survival and
postoperative
external
radiotherapy
(RT) in
with oligodendroglioma and 18 with mixed 40-61 Gy). Sixty-seven pts were treated of various factors (histology, gender, age, vs. no enhancement), type of surgery, total overall survival was investigated.
Results: The median overall survival time was 81 months, while the 5- and IO-year-survival rates (OS) were 54% and 31%, respectively.The median time to progression was 56 months, while the 5. and 10.year-progression-free survival rates (PFS) were 45% and 24%. Univariate analyses identified the total RT-dose (p=O.Ol), duration of symptoms (p=O.O5), seizures (p=O.O4), patient’s age (p=O.O3) and the CT pattern (p=O.OOS) as significant prognostic factors for OS. Progression-free survival rates were influenced by the identical factors. On multivariate analysis, only the age at diagnosis and the CT pattern remained independent prognostic factors for both PFS and OS. Conclusion: A minimum total dose of 52 Gy is recommended for the postoperative CT enhancement seem to need further intensification of treatment.
RT in low-grade
glioma.
Tumours
with
of the 41st Annual
ASTRO
Meeting
323
retrospective study to evaluate the impact of surveillance imaging on quality of life. However, because of the lack of quality of life data and small number of patients we still recommend surveillance imaging for these patients. We think it is worthwhile to study theses issues in a prospective setting and/or with larger data bank.
2088 Marshall Dept.
BRAIN STEM UNIVERSITY DT,
Mendenhall
of Radiation
GLIOMAS: OF FLORIDA NP, Marcus,
Oncology,
University
Purpose/Objective: Retrospective review stem glioma at the University of Florida.
LONG-TERM
SURVIVAL
AND
TOXICITY
OUTCOME
AT
THE
Jr RB of Florida
College
of survival
of Medicine,
and toxicity
outcome
Gainesville, in patients
FL,
USA
treated
with radiotherapy
(RT)
for brain
Materials & Methods: All patients with brain stem gliomas treated with RT at the University of Florida from 1980 to I996 were included in this study. Patients with lesions centered in the thalamus or cerebellum were excluded. Sixty patients met these criteria. The median age was 14 years (range, 2.4 to 66.3 y). Twenty patients were (21 years and 40 patients were 221 years of age. Follow-up ranged from 2 to 18 years (median, 8.25 y). Forty-two patients received hyperfractionated RT with a median dose of 70.2 Gy and a median dose per fraction of 1.17 Gy b.i.d. Eighteen patients received standard fractionation RT with a median dose of 54 Gy and a median dose per fraction of 1.79 Gy. Histologic grade of the tumors was as follows: no tissue diagnosis, 21; low grade, 17; intermediate grade, 15; high grade, 7. Patients were classified into one of three risk groups according to duration of symptoms and description of the radiographic appearance of the lesion. Two patients could not be classified into a risk group because of lack of information in the patients’ medical records. Seventeen patients were classified as low risk, 25 as intermediate risk, and 16 as high risk. All high grade and all high risk lesions were treated with b.i.d. RT. Two patients were treated with RT a second time for recurrence. Eleven patients received RT and chemotherapy (6 with bone marrow transplantation) and two patients received cisplatin-based regimens. Results: Actuarial overall survival at 5 years was 43% (71% for patients treated q.d. and 31% for patients treated b.i.d.; p = ,012). Five-year actuarial survival by histologic grade was as follows: 38% for no tissue diagnosis, 69% for low grade, 40% for intermediate grade, and 0% for high grade (p = .0056). Survival by risk group was as follows: 0% for not classified, 82% for low risk, 44% for intermediate risk, and 0% for high risk (p = .OOOl). Five-year actuarial survival was 38% for pediatric patients and 55% for adults (p = ,610). Chemotherapy showed no benefit to survival. Multivariate analysis of risk group, fractionation scheme, and age revealed only risk group as a statistically significant prognostic factor. Twenty-four patients lived >2 years (10 adults and 14 children). One adult suffered hearing loss. No adults suffered recurrent otitis, osteoradionecrosis. or cholesteatoma formation. Children suffered from hearing loss (57%) recurrent otitis media or externa (29%), osteoradionecrosis of the temporal bone (14%), or cholesteatoma formation (14%). Osteoradionecrosis and cholesteatoma formation only occurred in pediatric patients who received hyperfractionated RT (and, thus, a higher dose). Only 24 of 60 patients were alive at the time of analysis. Of these living patients, 13 were fully functional with only mild sequelae, 9 were functional but with moderate to severe complications, and 2 were ventilator dependent (attributed to location of tumor and attempted resection). Conclusions: This retrospective study supports recent randomized trials that show no benefit to hyperfractionation (and subsequent dose escalation) in the treatment of brain stem gliomas. All patients with high grade lesions or a combination of short duration of symptoms and a diffuse, infiltrating pattern on imaging studies died. Although higher dose, hyperfractionated RT does not appear to produce more hearing loss than standard fractionation schemes, it does appear to produce serious late sequelae such as osteoradionecrosis in a small percentage of pediatric patients, a side effect not reported with standard fractionation RT.
2089 Brunner University
SUPRATENTORIAL LOW GRADE GLIOMA: RESULTS FOLLOWING POSTOPERATIVE RADIOTHERAPY TB, Grabenbauer Hospitals
GG, Roedel
Erlangen,
Eulangen,
Purpose/Objective: To assess treatment 77 patients (pts) with low-grade glioma.
CM,
Paulus
W, Buchfelder
AND
M, Schrell
PROGNOSTIC
UH, Fahlbusch
FACTORS R, Sauer R
German) outcome
and prognostic
factors
following
Materials & Methods: Between 1977 and 1996, 45 pts with astrocytoma. 14 glioma received postoperative RT with a median total dose of 52 Gy (range immediately following surgery, ten pts with tumour progression. The influence seizures, duration of symptoms ( 6 weeks vs. 6 weeks), CT pattern (enhancement RT dose, timing of RT, proliferation and apoptosis) on relapse-free survival and
postoperative
external
radiotherapy
(RT) in
with oligodendroglioma and 18 with mixed 40-61 Gy). Sixty-seven pts were treated of various factors (histology, gender, age, vs. no enhancement), type of surgery, total overall survival was investigated.
Results: The median overall survival time was 81 months, while the 5- and IO-year-survival rates (OS) were 54% and 31%, respectively.The median time to progression was 56 months, while the 5. and 10.year-progression-free survival rates (PFS) were 45% and 24%. Univariate analyses identified the total RT-dose (p=O.Ol), duration of symptoms (p=O.O5), seizures (p=O.O4), patient’s age (p=O.O3) and the CT pattern (p=O.OOS) as significant prognostic factors for OS. Progression-free survival rates were influenced by the identical factors. On multivariate analysis, only the age at diagnosis and the CT pattern remained independent prognostic factors for both PFS and OS. Conclusion: A minimum total dose of 52 Gy is recommended for the postoperative CT enhancement seem to need further intensification of treatment.
RT in low-grade
glioma.
Tumours
with