title: Patterns of practice and survival in a retrospective analysis of 1722 adult astrocytoma patients treated between 1985 and 2001 in 12 Italian radiation oncology centers.
abstract: OBJECTIVE
  To analyze the patterns of practice and survival in a series of 1722 adult astrocytoma patients treated in 12 Italian radiotherapy centers.
  
  
  METHODS
  A total of 1722 patients were treated with postoperative radiotherapy (90% World Health Organization [WHO] Grade 3-4, 62% male, 44% aged >60 years, 25% with severe neurologic deficits, 44% after gross total resection, 52% with high-dose radiotherapy, and 16% with chemotherapy). Variations in the clinical-therapeutic features in three subsequent periods (1985 through 2001) were evaluated, along with overall survival for the different subgroups.
  
  
  RESULTS
  The proportion of women, of older patients, of those with worse neurologic performance status (NPS), with WHO Grade 4, and with smaller tumors increased with time, as did the proportion of those treated with radical surgery, hypofractionated radiotherapy, and more sophisticated radiotherapy techniques, after staging procedures progressively became more accurate. The main prognostic factors for overall survival were age, sex, neurologic performance status, WHO grade, extent of surgery, and radiation dose.
  
  
  CONCLUSIONS
  Recently, broader selection criteria for radiotherapy were adopted, together with simpler techniques, smaller total doses, and larger fraction sizes for the worse prognostic categories. Younger, fit patients are treated more aggressively, more often in association with chemotherapy. Survival did not change over time. The accurate evaluation of neurologic status is therefore of utmost importance before the best treatment option for the individual patient is chosen.
authors: Department of Radiation Oncology, University of Brescia, Brescia, Italy.
authors: Stefano Maria
authors: SM
authors: Magrini
authors: Umberto
authors: U
authors: Ricardi
authors: Riccardo
authors: R
authors: Santoni
authors: Marco
authors: M
authors: Krengli
authors: Marco
authors: M
authors: Lupattelli
authors: Ines
authors: I
authors: Cafaro
authors: Silvia
authors: S
authors: Scoccianti
authors: Claudia
authors: C
authors: Menichelli
authors: Filippo
authors: F
authors: Bertoni
authors: Riccardo Maurizi
authors: RM
authors: Enrici
authors: Vincenzo
authors: V
authors: Tombolini
authors: Michela
authors: M
authors: Buglione
authors: Luigi
authors: L
authors: Pirtoli