Treatment of supratentorial high grade XXXX with split course high fractional dose postoperative radiotherapy.

@entity1 @entity39 @entity1269 @entity11 @entity18489 @entity204
Ninety-two @entity1 with malignant @entity11 diagnosed from 1977 to 1983 received split course external beam radiotherapy. The initial course of radiation consisted of 3000 cGy whole brain in ten fractions 5 days a week. After a 2-week rest, treatment was continued to a portal restricted to the computerized tomography scan demonstrated abnormality plus a margin for an additional 2100 cGy (total 5100 cGy/17 fx/36 days). The optic chiasm and hypothalamus were excluded from the high dose region. Following review of all pathologic specimens, three @entity1 with @entity11 , three lacking histologic confirmation, two unbiopsied and eleven not receiving the prescribed treatment were excluded from the survival analysis. No @entity1 were lost to follow-up. Surviving @entity1 were followed 85 months (median); range 68-125 months. All remaining @entity1 were followed until @entity204 . The median actuarial survival for 73 grade III and IV @entity1 was 12.5 months. The 5-year actuarial survival was 10%. The median survival for 54 grade IV @entity1 was 10 months. The 5-year survival was 4%. For 19 grade III @entity1 the median survival was 22.5 months. The 5-year survival was 26%. There was one long-term grade IV survivor (68 mos.) and four long-term grade III survivors (76, 85, 108, 125 mos). No @entity1 developed @entity18489 . One @entity1 , an 85 months survivor, had biopsy documented radionecrosis and @entity1269 . The incidence of @entity39 among 62 @entity1 alive 6 months or more (and therefore at risk of @entity39 ) is 1/62 (2%). The incidence among survivors is 1/5. The nominal standard dose for this regimen is 1749 ret. The predictive value of the "nominal standard dose" and "equivalent dose" formulae for @entity39 is explored. We conclude (a) that this regimen provides a survival probability equivalent to conventional treatment for grade III and IV @entity11 , (b) that neither the equivalent nor nominal standard doses predicted the incidence of @entity39 , (c) that the time dose schedule is well tolerated and has an acceptable risk-benefit ratio, (d) that its advantage to the @entity1 is decreased time requirement and cost.
