PURPOSE: To evaluate the role of conventional postoperative adjuvant radiotherapy in the management of supratentorial malignant glioma and to determine favorable prognostic factors affecting survival. MATERIAL AND METHODS: From Sep. 1985 to Mar. 1997, the number of eligible patients who received postoperative radiotherapy completely was 69. They ranged in age from 7 to 66 years (median, 47). Forty-two (61%) patients were glioblastoma multiforme and the other 27 (39%) were anaplastic astrocytoma. Twenty patients (29%) had Karnofsky score equal or more than 80 preoperatively. Forty-three patients (62%) had symptom duration equal or less than 3 months. Twenty-four patients (35%) had gross total resection and forty patients(58%) had partial resection, the remaining five patients (7%) had biopsy only. Radiotherapy dose ranged from 50.4 Gy to 61.2 Gy (median, 55.8; mode, 59.4) with fraction size of 1.8 Gy-2.0 Gy for 33-83 days(median, 48) except three patients delivered 33, 36, 39 Gy, respectively with fraction size of 3.0 Gy due to poor postoperative performance status. Follow-up rate was 93% and median follow-up period was 14 months. RESULTS: Overall survival rate at 2 and 3 years and median survival were 38%, 20%, and 16 months for entire patients; 67%, 44%, and 34 months for anaplastic astrocytoma; 18%, 4%, and 14 months for glioblastoma multiforme, respectively (p=0.0001). According to the extent of surgery, 3-year overall survival for gross total resection, partial resection, and biopsy only was 38%, 11%, and 0%, respectively (p=0.02). The 3-year overall survival rates for patients age 40>, 40-59, and 60< or = were 52%, 8%, and 0%, respectively (p=0.0007). For the variate of performance score 80< or = vs 80>, the 3-year survival rates were 53% and 9%, respectively (p=0.008). On multivariate analysis including covariates of three surgical and age subgroups as above, pathology, extent of surgery and age were significant prognostic factors affecting overall survival. On another multivariate analysis with covariates of two surgical (total resection vs others) and two age (50> vs 50< or =) subgroups, then, pathology, extent of surgery and performancestatus were significant factors instead of age and 3-year cumulative survival rate for the five patients with these three favorable factors was 100% without serious sequela. CONCLUSION: We confirmed the role of postoperative conventional radiotherapy in the management of supratentorial malignant glioma by improving survival as compared with historical data of surgery only. Patients with anaplastic astrocytoma, good performance score, gross total resection and/or young age survived longest. Maximum surgical resection with acceptable preservation of neurologic function should be attempted in glioblastoma patients, especially in younger patients. But the survival of most glioblastoma patients without favorable factors is still poor, so other active adjuvant treatment modalities should be tried or added rather than conventional radiation treatment alone in this subgroup.
Astrocytoma ; Biopsy ; Follow-Up Studies ; Glioblastoma ; Glioma* ; Humans ; Multivariate Analysis ; Pathology ; Radiotherapy ; Radiotherapy, Adjuvant ; Survival Rate

Interstitial irradiation using high-activity Iridium-192 sources was studied clinically to treat supratentorial malignant astrocytomas(including glioblastoma multifrome). As of 1988, in attempt to define the efficacy of this technique in patients with more extensive disease, we treated patients less rigid selection criteria. 15 eligible patients have been approached and ten have accepted randomization for follow-up study over two years. Pathology was anaplastic astrocytoma in 5 patients, glioblastoma multiforme in 5 patients. Mean survival of patients treated with this procedure was 18.4 months. Continued investigation will determine which patient may benefit from this techique.
Astrocytoma* ; Brachytherapy* ; Follow-Up Studies ; Glioblastoma ; Humans ; Pathology ; Patient Selection ; Random Allocation

"Peripheral ring enhancement" of intracranial lesions in the CT examination is still being considered as a specific manifestation for abscess or a cyst tumor. The author analysed 33 cases with peripheral ring enhancement and concluded that although most of brain abscesses, metastatic brain tumors and cystic astrocytomas might demonstrate it, it was not specific for any diseases. To reach the correct diagnosis, it is necessary to collect and analyse the clinical features, laboratory data, and follow-up CT in addition to present CT findings. Examples of the various types of lesions that demonstrate peripheral ring enhancement are shown. It is suggested that various pathology could demonstrate "ring enhancement lesion", if CT scan were done at a fortuitous time. Some differential diagnostic suggestions are also made.
Abscess ; Astrocytoma ; Brain Abscess ; Brain Neoplasms ; Diagnosis ; Follow-Up Studies ; Pathology ; Tomography, X-Ray Computed*

Astrocytoma ; diagnosis ; genetics ; pathology ; surgery ; Gene Expression Regulation, Neoplastic ; Humans ; Prognosis

BACKGROUND: Mixed gliomas, such as oligoastrocytomas (OA), anaplastic oligoastrocytomas, and glioblastomas (GBMs) with an oligodendroglial component (GBMO) are defined as tumors composed of a mixture of two distinct neoplastic cell types, astrocytic and oligodendroglial. Recently, mutations ATRX and TP53, and codeletion of 1p/19q are shown to be genetic hallmarks of astrocytic and oligodendroglial tumors, respectively. Subsequent molecular analyses of mixed gliomas preferred the reclassification to either oligodendroglioma or astrocytoma. This study was designed to apply genetically integrated diagnostic criteria to mixed gliomas and determine usefulness and prognostic value of new classification in Korean patients. METHODS: Fifty-eight cases of mixed OAs and GBMOs were retrieved from the pathology archives of Seoul National University Hospital from 2004 to 2015. Reclassification was performed according to genetic and immunohistochemical properties. Clinicopathological characteristics of each subgroup were evaluated. Overall survival was assessed and compared between subgroups. RESULTS: We could reclassify all mixed OAs and GBMOs into either astrocytic or oligodendroglial tumors. Notably, 29 GBMOs could be reclassified into 11 cases of GBM, IDH-mutant, 16 cases of GBM, IDH-wildtype, and two cases of anaplastic oligodendroglioma, IDH mutant. Overall survival was significantly different among these new groups (p<.001). Overall survival and progression-free survival were statistically better in gliomas with IDH mutation, ATRX mutation, no microscopic necrosis, and young patient age (cut off, 45 years old). CONCLUSIONS: Our results strongly suggest that a genetically integrated diagnosis of glioma better reflects prognosis than former morphology-based methods.
Astrocytoma ; Classification ; Diagnosis ; Disease-Free Survival ; Genetics ; Glioblastoma ; Glioma ; Humans ; Necrosis ; Oligodendroglioma ; Pathology ; Prognosis ; Seoul

Astrocytoma ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Tomography, X-Ray Computed ; Tuberous Sclerosis ; complications ; diagnostic imaging ; pathology

OBJECTIVE: To determine the usefulness of perfusion MR imaging in assessing the histologic grade of cerebral gliomas. MATERIALS AND METHODS: In order to determine relative cerebral blood volume (rCBV), 22 patients with pathologically proven gliomas (9 glioblastomas, 9 anaplastic gliomas and 4 low-grade gliomas) underwent dynamic contrast-enhanced T2*-weighted and conventional T1- and T2-weighted imaging. rCBV maps were obtained by fitting a gamma-variate function to the contrast material concentration versus time curve. rCBV ratios between tumor and normal white matter (maximum rCBV of tumor / rCBV of contralateral white matter) were calcu-lated and compared between glioblastomas, anaplastic gliomas and low-grade gliomas. RESULTS: Mean rCBV ratios were 4.90'+/-1.01 for glioblastomas, 3.97'+/-0.56 for anaplastic gliomas and 1.75'+/-1.51 for low-grade gliomas, and were thus sig-nificantly different; p < .05 between glioblastomas and anaplastic gliomas, p <.05 between anaplastic gliomas and low-grade gliomas, p < .01 between glioblas-tomas and low-grade gliomas. The rCBV ratio cutoff value which permitted dis-crimination between high-grade (glioblastomas and anaplastic gliomas) and low-grade gliomas was 2.60, and the sensitivity and specificity of this value were 100% and 75%, respectively. CONCLUSION: Perfusion MR imaging is a useful and reliable technique for esti-mating the histologic grade of gliomas.
Adult ; Astrocytoma/*pathology ; Brain/pathology ; Brain Neoplasms/*pathology ; Cerebrovascular Circulation ; Contrast Media ; Female ; Gadolinium DTPA/diagnostic use ; Glioblastoma/*pathology ; Human ; *Magnetic Resonance Imaging ; Male ; Support, Non-U.S. Gov't

PURPOSE: Thallim-201 (201Tl) brain SPECT and proton (1H) magnetic resonance spectroscopy (MRS) have been used to evaluate tumor grade and viability of glioma. We assessed the correlations between 201Tl brain index or spectrum of metabolites of 1H MRS and grade of glioma or histopathologic findings. MATERIALS AND METHODS: We studied 17 patients (4 astrocytoma, 7 anaplastic astrocytoma and 6 glioblastoma). On 201Tl Brain SPECT, 201Tl index was measured as the ratio of average counts for region of interest to those for the contralateral normal brain. On 1H MRS, we calculated choline (Cho) /creatine (Cr) ratio and N-acetylaspartate (NAA)/Cr ratio in ROI defined as tumor center. Histopathologic findings were graded by Ki-67 index, cellularity, mitosis, pleomorphism, necrosis and endothelial proliferation. An unpaired t test and statistical correlations were performed to evaluate these data. RESULTS: Tl-index showed the best correlation with Ki-67 index (p<0.01), less correlations with cellularity, mitosis, and endothelial proliferation, but no correlation with results of MRS, pleomorphism, or necrosis. The findings of MRS did not correlate with all of the above. The cases of glioblastoma demonstrated a higher Tl-index, Cho/Cr ratio, Ki-67 index and lower NAA/Cr ratio, albeit without statistical significance. CONCLUSION: Even though 201Tl brain SPECT did not correlate directly with grade of malignancy, it may still be useful in determining biological aggressiveness of tumor and prognosis of patients because it correlated well with Ki-67 index, a growth fraction of glioma, cellularity, mitosis and endothelial proliferation.
Astrocytoma ; Brain* ; Choline ; Glioblastoma ; Glioma* ; Humans ; Magnetic Resonance Spectroscopy* ; Mitosis ; Necrosis ; Pathology* ; Prognosis ; Protons ; Tomography, Emission-Computed, Single-Photon*

Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited familial tumor syndrome. Benign tumors such as pilocytic astrocytoma, optic glioma make up the majority of intracranial neoplasms in patients with NF1. There have only been a handful of cases in which adult glioblastoma presented with NF1. A 32-year-old male presented with headache and radiological studies showing a high grade intra-axial tumor. The patient underwent gross total surgical excision and the pathology revealed glioblastoma. After the surgery, he received concomitant chemo-radiotherapy with temozolomide and adjuvant temozolomide chemotherapy. We report a NF1 patient who developed glioblastoma and reviewed related articles.
Adult ; Astrocytoma ; Brain Neoplasms ; Drug Therapy ; Glioblastoma* ; Hand ; Headache ; Humans ; Male ; Neurofibromatosis 1* ; Optic Nerve Glioma ; Pathology

A retrospective study of 29 cases of brain-stem gliomas(BSG's) from 1989 to 1993, was performed to determine prognostic factors. Our study also analyzed clinical features, growth patterns, pathologic findings and modalities of treatment in patients with brain-stem gliomas. The patients ranged in age from 6 to 65 years, most commonly in the first decade. The symptom duration prior to diagnosis was 1/2 to 6 months(mean 1 1/2 months). The most common symptom and sign were cranial nerve palsies, especially 6th or 7th cranial nerve. The growth patterns of BSG's were classified into diffuse tumors(7 patients), exophytic(9 patients), focal(2 patients) and cervicomedullary(1 patient). Twenty three of 29 patients were diagnosed pathologically by means of stereotactic biopsy(13 patients) and ope surgery(10 patients). The Pathologic findings were low grade astrocytoma in 9 patients, oligodendroglioma(3 patients), malignant astrocytoma(7 patients), and glioblastoma mulitiforme(4 patients). A significant correlation between diffuse growth pattern and malignant pathologic finding could be obtained(P=0.05). The methods of radiation therapy for BSG's were conventional(10 patients), hyperfractionated(13 patients), and Gamma knife radiosurgery(6 patients). The median survival time was 12 months. The Poor prognostic factors determined in our study were 1) short symptom duration prior to diagnosis(< or = 2 months), 2) diffuse growth pattern, 3) malignant pathologic finding, 4) tumor without cystic portion, and 5) tumor without hydrocephalus.
Astrocytoma ; Cranial Nerve Diseases ; Cranial Nerves ; Diagnosis ; Glioblastoma ; Glioma ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Pathology* ; Prognosis* ; Retrospective Studies