Vol.4, No 1, 1997 pp. 29 - 34
UC 616.831
THE LENGTH OF SURVIVAL IN PATIENTS WITH
HIGH GRADE ASTROCYTOMAS
Ivan Stefanović,
Zoran Milenković, Goran Ignjatović, Milorad Babić, Ivan Ivanov, Sladjana
Filipović
Neurosurgical Clinic, Faculty of Medicine, Niš, Yugoslavia
Summary. A retrospective analysis of the length of survival in operatively
treated patients harboring a Grade III and Grade IV astrocytomas in a 5-year
period (1985-1989) was carried out in our investigation. There were 121
patients with the above mentioned tumors, sixteen of them were excluded
from further analysis because of a lack of adequate follow-up, an age of
less than 18 years, and deaths in the early postoperative period mostly
due to cardio-pulmonar complications. Of the 105 remaining patients, 69
had Grade III tumors (65.7%) and 36 Grade IV tumors. The male-female ratio
was 7l:34 (67.6:32.3%). The majority of them were older than 40 years (91.42%),
only 9 patients were less than or equal to 40 years of age. The one year
survival rate had 1/3 of patients, two-years survival was found in 7% of
patients, there were 5% long-term survivors (more than 3 year-survival
rate) and only 1 patient lived longer than 5 years. Longer survival was
found in patients younger than or equal to 40 years of age (p<0.001),
in patients with Grade III tumors (p<0.024), in patients who were treated
by chemotherapy (p<0.017) and in those who underwent a repeated surgery
(p<0.00001). The sex had no statistical significance in relation to
the survival rate. All patients were treated with 42 Gy, 14 of them received
chemotherapy (p<0.017) as well. In the group of 15 patients who had
repeated surgery, proportionally more frequent were males 12 (16.9%), as
well as patients who were younger than or equal to 40 years of age (p<.087).
The length of survival after a repeated surgery was 3-4 times shorter than
after the first operation.
The multidisciplinary treatment of high-grade astrocytomas may contribute
to long term survival but real perspectives in the duration of life in
these patients might be expected after active immunologic treatment.
Key words: Astrocytoma, chemotherapy, repeated surgery, survival
DUŽINA PREŽIVLJAVANJA U PACIJENATA SA
VISOKOMALIGNIM ASTROCITOMIMA
Kratak sadržaj. Retrospektivno su analizirani operativno tretirani
astrocitomi III i IV stepena maligniteta, u periodu 1985-1989. godine.
Praćena je dužina preživljavanja u petogodišnjem periodu.Validnu grupu
činilo je 105 pacijenata.Analizom nije obuhvaćeno 16 pacijenata zbog uzrasta
mladjeg od 18 godina, neposrednog postoperativnog umiranja usled kardio-pulmonalnih
komplikacija, kao i nepotpune medicinske dokumentacije o postoperativnom
lečenju i vremenu smrti. Od 105 pacijenata validne grupe, 69 je imalo tumor
III stepena (65,7%),a 36 pacijenata tumor IV stepena.Muškaraca je bilo
71 (67,6%), žena 34. dominirali su stariji od 40 godina (91,4%), prema
svega 9 pacijenata mladjih od 40 godina. U seriji je zabeleženo jednogodišnje
preživljavanje u 1/3 pacijenata, dvogodišnje u 7 %, trogodišnje u 5 %,
dok je 5 godina preživeo samo 1 pacijent. Duže preživljavanje je zabeleženo
u pacijenata mladjih od 40 godina (p<0,001), sa histološkim gradusom
III (p<0,024), hemiotretiranih (p<0,017), odnosno reoperisanih pacijenata
(p<0,00001). Pol nije statistički značajno uticao na dužinu preživljavanja.
Svi pacijenti su u sklopu iradijacione terapije tretirani sa 42 Gy, a njih
14 bilo je podvrgnuto hemioterapiji (p<0,017). U grupi 15 reoperisanih
pacijenata procentualno zastupljeniji bili su muškarci 12 (16,9%), pacijenti
mladji od 40 godina (p<0,087), sa histološkim gradusom III
(p<0,021).Dužina preživljavanja posle reoperacije bila je
3-4 puta kraća nego posle prve operacije .
Zaključujemo da multidisciplinarni (neurohirurško-onkološki) pristup
lečenju visokomalignih astrocitoma može doprineti dužem preživljavanju
, ali se prave perspektive produženja života u takvih pacijenata očekuje
tek primenom aktivne imunološke terapije.
Ključne reči: Astrocitomi, hemioterapija, reoperacije, preživljavanje
