Fractionated stereotactic conformal radiation therapy of brain stem gliomas: outcome and prognostic factors

Background and purpose: Evaluation of outcome and prognostic factors in pat ients with brain stem glioma (BSG) following fractionated stereotactic radi otherapy (FSRT). Materials and methods: Between 1990 and 1997, we treated 41 patients with F SRT in a phase I/II trial. Median age was 24 years. Out of 36 patients with histologically proven glioma, ten had a partial tumour resection. Histolog y revealed low grade gliomas in 30 patients and anaplastic gliomas in six p atients. A mean total dose of 54 Gy was given in daily fractions of 1.8 Gy. Median follow-up was 12 months. Results: Three patients died during FSRT. Neurological improvement was achi eved in 19/38 patients. Reduction of tumour size was reported in 12/38, in 16 patients the lesion was unchanged, ten showed progression. Median time t o progression was 23 months, median overall survival 40 months with an actu arial survival of 83% at 1 year, 55% at 3 years and 33% at 5 years. In 20 o f 22 patients with recurrence progression was inside the target volume. Sig nificant prognostic factors for survival were clinical and radiological res ponse 6 weeks after FSRT. Treatment toxicity was mild. Ototoxicity occurred in one patient. Conclusions: FSRT is a feasible treatment modality for BSG with tolerable t oxicity. The risk of marginal failure is low. (C) 2000 Elsevier Science Ire land Ltd. All rights reserved.