Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report from three Radiation Therapy Oncology Group (RTOG) trials

Abstract

103 patients with the diagnosis of AAF were identified from the RT/BCNU arms of 3 RTOG malignant glioma trials. Pre-treatment tumor size was less than 5 cm for 48% and greater than or equal to 5 cm for 52%, and tumor sites were frontal lobe in 55%, temporal in 25%, and parietal in 16%. Surgery consisted of biopsy for 30%, partial resection for 56%, and total resection for 14%. Extent of surgery correlated with age, with 81% of patients less than 40 undergoing partial/total resection vs. 60% of those over 40 (P = 0.019). The median survival time (MST) of patients undergoing partial/total resection was 49 mo., vs. 18 mo. for those biopsied only (P = 0.002). Patients with frontal location had longer MST than those with non-frontal lesions (MST: 49 vs. 25 mo., P = 0.047), while no survival difference was apparent by univariate analysis of tumor size. Multivariate analysis demonstrated that only younger age, frontal location, and smaller tumor size correlated significantly with extended survival. Extent of surgery was not predictive. The close correlation between young age and extensive surgery obscures the survival advantage for greater surgery seen with univariate analysis. Smaller tumor size and frontal location favorably influence outcome even when adjusted by age.

Patterns of practice and survival in a retrospective analysis of 1722 adult astrocytoma patients treated between 1985 and 2001 in 12 Italian radiation oncology centers

“…However, median survival in the present series was much lower for patients undergoing biopsy alone (210 days) but not very different between the groups treated with "partial" or "radical" surgery (306 and 318 days, respectively). Similar data have been reported by Chang et al (34) and by other groups (35).…”

Nimotuzumab in combination with radiotherapy in high grade glioma patients

“…Patients' life expectancy is 24 mo and the standard of care consists of surgery, followed by RT or RT-CTP. 6,7 Epidermal growth factor receptor (EGFR) blockade as a therapy for cancer was first proposed by J Mendelssohn during the 1980s. 8 In the past 20 y, considerable preclinical and clinical experimental evidences have demonstrated the efficacy of EGFR blockade for cancer therapy and the identification of powerful and selective inhibitors of the EGFR activation has been one of most successful areas of cancer research.…”

Nimotuzumab prolongs survival in patients with malignant gliomas: A phase I/II clinical study of concomitant radiochemotherapy with or without nimotuzumab

“…Retrospective reviews have indicated that surgery increases survival time in malignant glioma patients (5). Radiation Therapy Oncology Group data have indicated that surgical resection was associated with statistically significantly longer survival and median survival time (6).…”