gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Minimally invasive therapy of supratentorial WHO grade II astrocytoma by interstitial radiosurgery: long-term results

Langzeitergebnisse minimal invasiver Therapie bei supratentoriellen WHO-II-Astrozytomen mittels interstitieller Radiochirurgie

Meeting Abstract

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  • corresponding author S. Grau - Neurochirurgischer Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • U. Faist - Neurologische Klinik, Albert-Ludwigs-Universität, Freiburg
  • C.B. Ostertag - Abt. für Stereotaktische Neurochirurgie, Albert-Ludwigs-Universität, Freiburg
  • F.W. Kreth - Neurochirurgischer Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.11.09

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Veröffentlicht: 8. Mai 2006

© 2006 Grau et al.
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Objective: Besides open resection and external beam radiation, interstitial radiosurgery provides a minimal invasive therapeutic approach in treating World Health Organization (WHO) Grade II astrocytoma or oligoastrocytoma. However, detailed long-term outcome data are not available for adult patients up to now. Here we show long term follow up data of 239 patients with supratentorial WHO II astrocytoma/oligoastrocytoma treated with interstitial radiosurgery.

Methods: A previously assessed cohort of 239 adult patients with circumscribed supratentorial de-novo astrocytoma (187 patients) and oligoastrocytoma (52 patients) treated with interstitial Iodine-125 (I-125) radiosurgery as primary treatment (1979-1992) was revisited for long term data. Survival, progression-free survival, functionally independent survival, post-recurrence survival and time to malignant transformation were estimated with the Kaplan Meier method. Prognostic factors were obtained from the Cox multivariate proportional hazards model.

Results: Five-, 10- and 15-year survival (progression free survival) was 56% (45%), 37% (21%) and 26% (14%), respectively (median follow-up: 10.3 years). The corresponding malignant transformation rates were 33%, 54%, and 67%. No levelling off of the Kaplan-Meier curves could be observed for any of the chosen endpoints. Age >50 years, a tumor volume >20 ml and/or a Karnofsky score ? 80 were associated with decreased survival/progression-free survival. Age >35 years and/or a tumor volume >20 ml increased the risk of malignant transformation. Prognostic factors determined subsets of patients with 10-year survival (progression-free survival) ranging from as low as 6% (1%) to as high as 55% (31%), respectively. Transient radiogenic complications occurred in 19 patients, eight patients developed a space occupying radionecrosis. No procedure related complications.

Conclusions: Long-term tumor stabilization is rare. As the outcome is mainly determined by treatment-independent factors, the minimization of any treatment-related risk must be considered essential. Thus, interstitial radiosurgery represents a minimal invasive and safe treatment option.