[Therapy of brain stem tumors--palliative concept with a curative perspective?]

From 1969 to 1981, 23 patients with tumors in the pons region were irradiated at the Department of Radiotherapy of the West German Tumor Center in Essen. The age of the patients ranged from 18 months to 50 years. Fifteen patients (65%) were younger than 18 years, one was 25 years old, and seven were between 40 and 50 years old. In two cases the histologic diagnosis of an astrocytoma I and astrocytoma II could be confirmed by exploratory excision and cyst punction, respectively. Nineteen patients received a shunt system (ventriculoatrial shunt) prior to radiotherapy in order to achieve a pressure reduction. After a follow-up period of 1.5 to 12 years, eleven patients are alive, and twelve patients died from a local recurrence or from progressive tumor growth. The five-year survival rate is 47%. Five of the surviving patients show no or only slight adverse effects on their general condition and are able to attend school or carry out their profession (in Karnofsky: 90 to 100%). Four other patients suffering from marked remaining neurologic symptoms are able to take care of themselves (Karnofsky: 70 to 80%). Two patients need permanent nursing (Karnofsky: 50 to 60%). Because of the local propagation tendency of pons tumors, radiotherapy should be locally restricted to the brain stem and the adjacent brain structures, e.g. cerebellum and proximal neck marrow. The authors recommend target volumes of 55 to 60 Gy, which must be applied within 6 to 8 weeks, taking into account the age of patients. This palliative therapy conception should be applied routinely in the hope of bringing about a curative treatment to this group of patients.