XXXX : does deferring treatment compromise outcome?

@entity1 @entity410 @entity5 @entity11 @entity3271
This study reports the University of Florida experience treating @entity3271 with the goal of identifying the factors that predict favorable outcome. Between 1958 and June 1998, 51 @entity1 (aged 5-75 years) were diagnosed with pure @entity3271 at the University of Florida. Histologic grade was anaplastic in 19 @entity1 , low-grade in 30 @entity1 , and unknown in one @entity1 . Twelve @entity1 were treated with surgery alone (10 with @entity5 ). Thirty-nine @entity1 underwent postoperative radiotherapy after surgery (plus chemotherapy in four @entity1 ). A biopsy was performed in 10 @entity1 , 40 underwent subtotal or gross total resection, and one had surgery of unknown extent. Thirteen @entity1 with a radiographic abnormality consistent with a @entity11 had the initiation of definitive treatment (i.e., surgery with or without radiotherapy) deferred for a median of 4.5 years before undergoing treatment for worsening symptoms or radiographic progression. Absolute survival for the entire group (51 @entity1 ) at 5, 10, and 20 years from the date of initial treatment was 61%, 37%, and 31%, respectively, and at 5, 10, and 20 years from the date of initial diagnosis was 65%, 43%, and 34%, respectively. No @entity1 died of intercurrent disease. Multivariate analysis for absolute survival from the time of initial treatment demonstrated young age (young @entity1 fared better than older @entity1 ) and size (<5 cm better than > or =5 cm) to be significant variables. No @entity1 under the age of 21 years (n = 8) at the time of diagnosis has died in this series. Deferring aggressive treatment did not alter survival. Multivariate analysis for favorable absolute survival based on the time from initial diagnosis demonstrated young age and presentation with @entity410 alone to be statistically significant for favorable outcomes. Approximately one third of @entity1 with @entity3271 appear to be cured with aggressive treatment. Age is the most important predictor of long-term progression-free and absolute survival with young @entity1 (especially aged <21 years) doing much better than older @entity1 . Deferring aggressive treatment (surgery and/or radiation) until symptoms clearly indicate @entity5 progression does not compromise outcome for a select group of @entity1 who are diagnosed at a young age with a nonenhancing mass on MR and @entity410 as the lone presenting symptom.
