SURVIVAL AFTER STEREOTAXIC BIOPSY AND IRRADIATION OF CEREBRAL NONANAPLASTIC, NONPILOCYTIC ASTROCYTOMA

The authors investigated the outcome of stereotactic biopsy and radiot herapy in 35 consecutive adult patients with nonanaplastic, nonpilocyt ic astrocytomas who were diagnosed between 1982 and 1992. The median p atient age at presentation was 32 years. All received fractionated ext ernal-beam radiation therapy (median dose 56 Gy) as the initial manage ment strategy. Additional treatment in two patients included intracavi tary irradiation with colloidal phosphorus-32. Six patients (17%) had documented tumor progression during the follow-up interval and died. T hree others died of causes unrelated to their tumor. Median survival a fter stereotactic biopsy and irradiation was 118 months (9.8 years). M edian survival from the time of onset of neurological symptoms was 148 months (12.3 years). Only three patients required delayed cytoreducti ve surgery. The outcome of brain astrocytomas, although improved becau se of earlier diagnosis and therapy, does not substantiate this tumor as having benign behavior; early recognition with neuroimaging, immedi ate histological diagnosis via stereotactic biopsy, and initial fracti onated radiation therapy may provide the potential for longer survival for patients with low-grade astrocytomas. The majority of such surviv ing patients have a satisfactory quality of life, which is manifested by prolonged normal functional and employment status. The survival dat a reported in this prospective Phase I-II clinical trial suggest that stereotactic biopsy and radiation therapy are appropriate initial mana gement strategies for astrocytomas.