LONG-TERM SURVIVAL IN PATIENTS WITH MALIGNANT ASTROCYTOMA

FROM 1978 TO 1988, 314 patients with malignant astrocytoma were treate d by our neuro-oncology team. Twenty-five patients were excluded from further analysis because of a lack of adequate follow-up, the brain-st em location of the tumor, or an age of less than 18 years. Of the 289 remaining patients in the valid study group, 213 had Grade IV tumors ( 73.7%) and 76 had Grade I II tumors; 167 patients were male (57.8%) an d 112 were female, and 89 were less than 40 years of age (30.8%). Ther e were 58 long-term survivors (> 36 mo) in the series (20%). Long-term survivors were much more likely to be less than 40 years of age (x = 41.8; P < 0.005), to have undergone repeated surgery (x = 17.3; P < 0. 005), to have received more than 60 Gy of radiation (x = 11.6; P < 0.0 05), to have Grade III tumors (x = 10.6; P < 0.005), and to have recei ved nitrosoureas (x = 6.09; P < 0.02). Neither sex nor blood type were significantly associated with long-term survival. Patients undergoing repeated surgery were more likely to be less than 40 years of age (x = 5.72; P < 0.02), but neither sex nor histological findings was assoc iated with repeated surgery. For the series as a whole, the observed 5 -year survival rate was 6%. We conclude that an aggressive multidiscip linary approach can produce sizable numbers of long-term survivors in malignant astrocytoma patients with favorable prognostic factors.