ABSTRACT
One hundred successive patients with malignant gliomas were studied to assess prognostic features and effects of aggressive surgical and radiation management. The group included 53 patients with glioblastoma multiforme, 40 with anaplastic astrocytomas, 5 with malignant mixed gliomas, and 2 with anaplastic oligodendrogliomas. Treatment principles included maximum safe resection and aggressive radiation therapy including stereotactic implantation of I[125] high activity seeds. Sixty-seven patients had resection of their tumour as the initial treatment and 33 had stereotactic biopsy. Interstitial brachytherapy was possible in 27 patients and re-operation was carried out in 37. There was an average of 1.46 operations per patient. The median survival for patients with glioblastoma was 57 weeks and anaplastic astrocytoma 104 weeks. Five factors were statistically independently important in outcome; age, histological type, Karnofsky score, use of stereotactic brachytherapy, and extent of surgery. Age was the most important prognostic factor; for patients below 40, median survival was 182 weeks and for those above, 40-56 weeks [p< 0.0003]. Tumour type was next in importance, with 57 weeks median survival for glioblastomas and 104 weeks for anaplastic astrocytomas [p< .005]. Brachytherapy increased median survival from 50 to 107 weeks [p< .015]. Surgical resection also increased survival; patients with a biopsy had a survival of 48 weeks and resection 82 weeks [p< .023]. Karnofsky score had a less strong favourable prognostic value than surgery [p< .03]. These data suggest that aggressive surgery and high dose focal radiotherapy are helpful to individual patients in managing both glioblastomas and malignant astrocytomas, almost doubling survival time