1567 / 1708
75%, respectively, and for those treated by any surgery
alone 49% and 37%, respectively.
Adjuvant radiation was associated with higher LC.
The 10-year LC rates with or without adjuvant RT
were 86% and 46%, respectively (
P
= 0.03).
Regarding the extent of surgery, the 10-year LC rate
for patients who had GTR with and without adjuvant
RT were 90% and 58%, respectively (
P
= 0.01). The
LC rate for patients who underwent STR plus
adjuvant RT was 90% at 10 years, whereas two
patients who had STR alone experienced local
recurrence.
Patterns of failure
Table 2 shows the primary tumor site and the initial
and salvage treatments used. All 12 recurrences were
in the neural axis, and most were within the primary
site. Overall, eight patients had failures within the
primary site alone, three in the distant neural axis only,
and one at the primary site and in the distant neural
axis. Regarding the extent of surgery, disease recur-
rence was experienced by 5 (45%) of 11 patients who
had GTR alone, 1 (10%) of 10 patients who had GTR
plus adjuvant RT, 2 (100%) of 2 patients treated with
STR alone, and 4 (33%) of 12 patients treated with
STR plus adjuvant RT.
Of the 12 patients, 8 (67%) with treatment failures
underwent successful salvage therapy with further
surgery, RT, and/or chemotherapy (2 patients re-
ceived oral 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosurea
(CCNU) 130 mg/m
2
monthly for 12 courses, one
received intrathecal mafosfamide 5 mg monthly for 18
courses, and one received oral procarbazine 125 mg/m
2
monthly for 6 courses). Three of these patients were
alive with disease at last follow-up, at 4–21 years
following their relapse.
Neurologic functional outcome after adjuvant RT
All patients tolerated RT completing their prescribed
therapy without interruption. The median follow-up
time for patients undergoing adjuvant RT was
11.5 years (range, 2.9–33 years). Before adjuvant RT, 7
patients (32%) were classified as Frankel grade E, 13
patients (59%) as grade D, and 2 patients (9%) as
grade C. There was no patient classified as grade A or
B before adjuvant RT. Ten patients (45%) maintained
their pretreatment neurological status up to the last
follow-up visit (7 patients were grade E, 2 were grade
D and 1 was grade C). Eleven patients (50%) experi-
enced improved neurologic function after treatment
(10 patients changed from grade D to E, 1 patient from
grade C to D). One patient (5%) with grade D changed
to grade B after multiple surgeries for tumor progres-
sion (Fig. 4).
0
25
50
75
100
Proportion
Surgery Alone
Surgery& Adjuvant RT
p
= 0.04
Years
No. At Risk:
Surgery Alone
Surgery+AdjRT
13
5
2
1
22
15
12
5
5
15
0
10
Fig. 3
Progression-free survival according to initial treatment
groups (i.e., surgery alone vs. surgery and adjuvant radiotherapy,
P
= 0.04)
0
25
50
75
100
Years
Proportion
No. At Risk: 35
28
21
9
5
15
0
10
Fig. 1
Overall survival for the entire group
0
25
50
75
100
Years
Proportion
No. At Risk: 35
19
13
5
5
15
0
10
Fig. 2
Progression-free survival for the entire group
J Neurooncol (2006)
123