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Fig. 3. Freedom from leptomeningeal failure by tumor grade (1 and 2 vs. 3 and 4).

Fig. 1. Freedom from local failure by tumor grade (1 and 2 vs. 3 and 4).

curred in 7 of 70 patients (10%) with low-grade tumors and 3 of 10 patients (30%) with high-grade tumors. The actu- arial 5-year leptomeningeal failure rates were 10% for pa- tients with low-grade tumors as compared to 41% for those with high-grade tumors ( p 5 0.01) (Fig. 3). Radiotherapy field arrangement did not significantly alter the risk of leptomeningeal seeding. The 5-year leptomeningeal failure rate was 9% for those treated with local fields, 11% for those treated with whole brain or whole spine fields, and 24% for those treated with craniospinal axis fields ( p 5 0.4). Patterns of failure for both low- and high-grade tumors were evaluated in detail (Table 4). The predominant pattern of failure was local failure, which was sometimes accompa- nied by leptomeningeal failure. Isolated leptomeningeal failures were uncommon, occurring in only 5% of patients. Only one patient failed in non-CNS sites (scalp, lungs, and kidneys). This individual developed leptomeningeal seeding prior to widespread metastases. Survival Actuarial 5-, 10-, and 15-year survival rates for the entire study group were 79%, 73%, and 61%, respectively (Fig. 4). Tumor size, patient age, sex, radiotherapy field arrange- ment, and radiation dose were not significantly associated

One patient received chemotherapy as a component of initial treatment (dianhydrogalactitol, triazinate, etoposide, Table 3). Salvage chemotherapy was administered to 8 patients when disease progression was documented after initial treatment. Various combinations of the following agents were administered: dianhydrogalactitol, triazinate, etoposide, semustine, procarbazine, diaziquone, vincristine, prednisone, cis-platin, and methotrexate. Patterns of failure Local control rates at 5 and 10 years were 75% and 70%, respectively. The 5-year local control rates were 83% for patients with low-grade tumors as compared to 20% for those with high-grade tumors ( p , 0.0001) (Fig. 1). Patients with primary tumors measuring less than 3.5 cm in diameter had a 5-year local control rate of 80% as compared to 70% for larger tumors ( p 5 0.049) (Fig. 2). Additional factors evaluated and not significantly associated with local control included the extent of resection, radiation dose, field ar- rangement, patient age, sex, or the histologic subtype (myxopapillary vs. others). Leptomeningeal dissemination following therapy oc- RESULTS

Fig. 2. Freedom from local failure by tumor size.