Optimal Radiation Therapy Field for Malignant Astrocytoma and Glioblastoma Multiforme / 대한방사선종양학회지

PURPOSE: This study was performed to determine the optimal radiation therapy field for the treatment of malignant astrocytoma and glioblastoma multiforme. MATERIALS AND METHODS: From Jan. 1994 to Mar. 2000, 21 patients with malignant astrocytoma and glioblastoma multiforme, confirmed as recurrent by follow up MRI after surgery and radiation therapy, were analyzed. The distance from the margin of the primary lesion to the recurrent lesion was measured. The following factors were analyzed to investigate the influence of these factors to recurrence pattern; tumor size, degree of edema, surgical extent, gamma knife radiosurgery and multiple lesions. RESULTS: Among the 21 patients, 18 (86%) were recurred within 2 cm from the primary lesion site. 12 within 1 cm, 6 between 1 and 2 cm. The other 3 patients all with multiple lesions, were recurred at 3, 4, 5 cm, from the primary lesion site. The recurrence pattern was not influenced by the factors of tumor size, extent of edema, surgical extent, or gamma knife radiosurgery. However, patients with multiple lesions showed a tendency of recurrence at sites further from the primary lesion. CONCLUSIONS: Most (86%) of the recurrences of malignant astrocytoma and glioblastoma multiforme occurred within 2 cm from the primary lesion site. The width of treatment field does not need to be changed according to tumor size, degree of edema, surgical extent, or gamma knife radiosurgery. However, the treatment field for multiple lesions appears to be wider than that for a single lesion.

Clinical Analysis of Stereotactic Brachytherapy with High-Activity Iridium-192 Sources for Treatment of Malignant Astrocytomas

Interstitial irradiation using high-activity Iridium-192 sources was studied clinically to treat supratentorial malignant astrocytomas(including glioblastoma multifrome). As of 1988, in attempt to define the efficacy of this technique in patients with more extensive disease, we treated patients less rigid selection criteria. 15 eligible patients have been approached and ten have accepted randomization for follow-up study over two years. Pathology was anaplastic astrocytoma in 5 patients, glioblastoma multiforme in 5 patients. Mean survival of patients treated with this procedure was 18.4 months. Continued investigation will determine which patient may benefit from this techique.

Radiotherapy Results of Malignant Astrocytoma and Glioblastoma Multiforme / 대한치료방사선과학회지

A retrospective analysis was performed on 53 patients with brain malignant astrocytoma and glioblastoma multiforme treated with surgical resection and postoperative radiotherapy in the period between January 1980 and June 1991. There were 13 patients with malignant astrocytoma, 40 patients with glioblastoma multiforme. Survival rates were analyzed according to histologic grade, age, performance states, extent of surgical resection, tumor location, symptom duration, total radiation dose and addition of chemotherapy after radiation therapy. 5 year actuarial survival rate for malignant astrocytoma was 29.4%, for glioblastoma multiforme was 2.8%. Histologic grade, age, performance status, total radiation dose were statistitically significant prognostic factors.

Treatment of 135 patients with malignant astrocytoma / 中华放射肿瘤学杂志

Purpose: To analyze the treatment effects by radiotherapy alone and radiotherapy plus chemotherapy of carotid artery intubation after operation for malignant astrocytoma. Materials and Methods: 135 patients with malignant astrocytoma were treated from August, 1987 to November, 1992. Patients were divided into two groups after operation: 71 patients received radiotherapy alone and 64 patients,combination therapy of chemotherapy (BCNU) plus radiotherapy. All patients received DT 55～70Gy. In combination therapy group, BCNU(250mg) was given daily by carotid artery intubation for 4～15 days.Radiotherapy was given 10～15 days after chemotherapy, then followed by 1～3 intubation. Results: The median survival were 17.5 months in radiotherapy alone group and 31.9 months in combination one.Patients with glioblastoma gave the better results with the 2-,3-,and 5- year survivals of 70%, 36% and 15%, respectively. Conclusion: Chemotherapy (BCNU) of intubation plus radiotherapy is preferable in treating malignant astrocytoma after operation.

Clinical Analysis of Brain Stem Glioma

The authors reviewed the cases of 25 patients, who were diagnosed as brain stem glioma by computerized tomography. The common presenting complains were the cranial nerve palsies, long tract signs and cerebellar dysfunction. Four distinct types of brain stem gliomas were identified based on CT scan characteristics: Type I included diffuse tumors; Type II included focal tumors; Type III included tumors involving cervicomedullary portion; Type IV(a) included exophytic tumors extending ventrally or laterally into the cerebellopontine or prepontine cistersns; Type IV(b) included exophytic tumors extending dorsally into fourth ventricle. The clinical presentation, efficacy of surgical intervention, pathology, and prognosis of those tumors were correlated within these typing. The prognosis was poorer in children who presented with multiple cranial nerve palsies, and such children were more likely to have malignant astrocytoma. Type I(diffuse tumors) had the poorest prognosis and less response to radiation while Type II(focal tumors) had relatively good response to radiation. Through surgery and post operative radiotherapy, survival times were significantly longer in patients with Type III(cervicomedullary tumor) which was more likely to be low grade astrocytoma. The prognosis of patients with Type IV-b(4th ventricle tumor) was variable but better than those with Type IV-a(prepontine tumors) or Type I(diffuse tumors). Patient with tumor biopsies that were histologically benign survived significantly longer than those whose tumors were malignant. It is concluded that patient with Type III cervicomedullary tumors or Type IV exophytic tumor may be improved through surgery and postoperative radiotherapy, and radiotherapy is useful method in treatment of patients with Type I diffuse tumors or Type II focal tumors.

Primary Intracranial Tumors of Different Histological Types(Multiple Primary Brain Tumors): Report of Two Cases

The presence of multiple, diverse primary brain tumors is infrequent in patients without phakomatosis. We wish to report two cases of multiple primary brain tumors. The first case, a 38-year-old female, suffered from headache, bilateral hearing loss for about 6 years prior to hospitalization. Camputed tomography scan demonstrated multiple well enhanced masses in the right frontal convexity, falx and both cerebellopontine angles. These lesions were removed successfully in 3 successive operations. Histologically the tumors were diagnosed as afibroblastic meningiomas and a acoustic neurinoma. Although none of the cutaneous stigmata of von Reck1inghausen's disease has been observed in her and any member of her family, we cant's exclude this case that belongs in the central form of neurofibromatosis. The 2nd case, a 71-year-old male, suffered from frontal headache with confusion for about 7 days prior to hospitalization. Computed tomography scan demonstrated a ring enhanced mass with surrounding edema in the left frontal lobe. The left frontal osteoplastic craniotomy was performed, a small mass with the dura attached could be found incidentally, and this small mass and the ring enhanced tumor in the frontal deep portion were grossly totally removed. Histologically the two tumors were dIagnosed as a menigotheliomatous meningioma and a malignant astrocytoma.