Radiotherapy in supratentorial gliomas: A study of 821 cases

• Published in: Strahlentherapie und Onkologie 2003-09, Vol.179 (9), p.606-614
• Main Authors: HEESTERS, Mart, MOLENAAR, Willemina, GO, Gwan K
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Astrocytoma - mortality; Astrocytoma - radiotherapy; Biological and medical sciences; Brachytherapy; Brain cancer; Cancer; Data Interpretation, Statistical; Decades; Diseases of the nervous system; Follow-Up Studies; Glioblastoma - mortality; Glioblastoma - radiotherapy; Glioma - mortality; Glioma - radiotherapy; Gliosarcoma - mortality; Gliosarcoma - radiotherapy; Humans; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Neurologic Examination; Oligodendroglioma - mortality; Oligodendroglioma - radiotherapy; Prognosis; Radiation therapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Factors; Supratentorial Neoplasms - mortality; Supratentorial Neoplasms - radiotherapy; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-003-1098-9

Analysis of the results of radiotherapy in a large group of cerebral gliomas with identification of prognostic factors and the outcome with respect to different decades of treatment. Two decades (1979-1999) of radiotherapy in supratentorial astrocytic and oligodendroglial tumors (n = 821) at the University Hospital Groningen were retrospectively evaluated. Prognostic factors for survival were analyzed. Two decades of radiotherapy treatment were compared with respect to radiotherapy dose and treatment-field design. Glioblastoma multiforme, including gliosarcoma, was the most frequent supratentorial glioma (n = 442) with a poor survival, i.e., median survival time (MST) 7 months, especially in patients > 50 years of age and with poor performance. Patients with good performance were selected for radiotherapy with an optimum dose of 60 Gy local-field irradiation. However, in patients with poor prognosis, no radiotherapy was applied or a shorter treatment scheme was given. Anaplastic astrocytomas (n = 131) were treated in the same way as glioblastoma multiforme. Over time, a decrease in radiation dose (from 60 to 45 Gy) and from whole brain irradiation to local-field treatment was observed, following the literature. In low-grade gliomas, prognostic factors for survival were age, performance, and extent of resection. Gemistocytic astrocytoma (n = 15) had an inferior survival compared to astrocytoma (MST 46 vs. 54 months), but a superior survival compared to anaplastic astrocytoma (MST 10 months). The presence of an oligodendroglial component in a glioma implied a superior survival compared to the astrocytic gliomas. The inherent biology of the glioma is reflected by the study of recurrent tumors with progression to higher grades of malignancy in 32-40% and by the histology of recurrent oligodendroglial tumors. In comparing two decades of radiotherapy in gliomas, no differences in survival were observed despite the technological improvements. However, reduction in long-term side effects was not evaluated, especially in low-grade gliomas which were treated in the second decade of the study with local fields only and a reduced radiotherapy dose using computerized three-dimensional (3-D) planning. Radiotherapy does not cure cerebral glioma. Prognostic factors for survival are histopathologic classification and grading, age, and patient performance. Technological improvements do not improve survival, but possibly reduce late effects.