Abstract
The authors report prolonged survival in patients with high grade (grade 3 and 4) gliomas who were given additional intraoperative radiation therapy (IORT) and discuss survival in relation to the immunocytochemical assessment of their tumours. Of 54 selected patients with high grade gliomas treated with multimodal therapy including IORT during the years from 1985 to 1989, 11 had long-term survival over 5 years after the initial treatment. The clinicopathological features, analysed retrospectively, that were associated with prolonged survival were: (1) epileptic seizures, (2) initial CT scans showing a small mass without contrast enhancement which developed into an enhancing larger mass on follow up, (3) tumour location which was frequently frontal and near the cortical surface, (4) 20–30 Gy irradiation (mean 25.5 Gy) in IORT delivered in one fraction to the post-resection tumour bed, and (5) a low proliferating cell nuclear antigen (PCNA) labelling index (LI). The most favourable prognostic indicator was found to be a low PCNA LI.
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