[Postoperative irradiation in grade III and IV astrocytoma]

The aim of this paper is to contribute to the discussion on the value of postoperative radiotherapy in patients with astrocytoma grade III-IV. One hundred and fifteen of the 243 patients with histologically proven astrocytoma grade III-IV received postoperative radiotherapy at the St. Radboud University Hospital Nijmegen. According to the protocol all patients with a fairly good performance status were irradiated. The extent of surgery consisted of biopsy alone in 11%, subtotal tumour resection in 85% and macroscopically complete tumour removal in 4%. All patients received a whole brain irradiation of 40 Gy with a boost of 10-15 Gy in the tumour. Patients with grade III who underwent surgical resection had a median survival of 2.1 months, those with grade IV 2.7 months. Patients who underwent surgical resection and radiotherapy had a median survival of 12 months (grade III) and 8.6 months (grade IV). The extent of surgery and grade of malignancy were the only prognostic factors. Because of the selection of patients this study produces no additional arguments in favour of postoperative radiotherapy. However, we continue our treatment strategy to irradiate patients with grade III-IV tumours because the median survival obtained with this strategy is high in comparison with data from literature.