Poorer local control after radiotherapy for MSCC is associated with visceral metastases and short-course radiotherapy. Long-course radiotherapy seems preferable for patients with more favorable prognoses, given that these patients may live long enough to develop MSCC recurrences. Long-term survival after radiotherapy for MSCC may be predicted if several prognostic factors are considered.

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Most neurocytomas are well differentiated, being associated with better long-term survival than the more aggressive atypical lesions. Atypical neurocytomas are characterized by an MIB-1 labeling index >3% or atypical histologic features. This analysis focuses on well differentiated neurocytomas in order to define the optimal treatment. A case with a follow-up of 132 months is presented. The patient developed two recurrences two and four years after first surgery, each showing an increasing proliferation activity. Furthermore, all published well-differentiated neurocytoma cases were reviewed for surgery, radiotherapy, and prognosis. Additional relevant data were obtained from the authors. Complete resection (CTR), complete resection plus radiotherapy (CTR + RT), incomplete resection (ITR), and incomplete resection plus radiotherapy (ITR + RT) were compared for outcome by using the Kaplan-Meier method and the log-rank test. Data were complete in 301 patients (CTR, 108; CTR + RT, 27; ITR, 81; ITR + RT, 85). Local control and survival were better after CTR than after ITR (P < 0.0001 and P = 0.0085, respectively). Radiotherapy improved local control after ITR (P < 0.0001) and after CTR (P = 0.0474), but not survival (P = 0.17 and P = 1.0, respectively). In the ITR + RT group, doses < or =54 Gy (n = 33) and >54 Gy (n = 32) were not significantly different for local control (P = 0.88) and survival (P = 0.95). The data demonstrated CTR to be superior to ITR for local control and survival. After CTR and ITR, radiotherapy improved local control, but not survival. A radiation dose of 54 Gy appeared sufficient. Application of postoperative radiotherapy should be decided individually, taking into account the risk of local failure, the need for another craniotomy, and potential radiation toxicity.

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Based on the data published since 1982 and on additional data from the authors, this retrospective analysis compares four different therapeutic approaches in the treatment of central neurocytoma: complete resection (n = 108), complete resection plus radiotherapy (n = 30), incomplete resection (n = 74), and incomplete resection plus radiotherapy (n = 98). The data suggest that complete resection leads to significantly better local control and survival than incomplete resection. After incomplete resection, patients benefit from postoperative radiotherapy.

BACKGROUND The majority of central neurocytomas are benign. Approximately 25% of these rare central nervous system tumors are more aggressive, with an MIB‐1 labeling index > 2% or atypical histologic features, and are classified as atypical neurocytomas. The objective of this analysis was to define the optimal treatment for patients with these atypical tumors. METHODS The first atypical neurocytoma was described in 1989. The patients reported since then were reviewed for age, gender, extent of resection, MIB‐1 index, histology, irradiation, local control, and survival. In addition to the data available in the literature, more relevant data were obtained from the authors of that literature. Treatment approaches included complete resection alone (CR), complete resection followed by radiotherapy (CR‐RT), incomplete resection alone (IR), and incomplete resection followed by radiotherapy (IR‐RT). These four therapies were compared for local control and survival using Kaplan–Meier analysis and the log‐rank test. RESULTS Complete data were available on 85 patients (15 patients who underwent CR, 13 patients who underwent CR‐RT, 17 patients who underwent IR, and 40 patients who received IR‐RT). Local control rates at 3 years and 5 years were 73% and 57% after CR, 81% and 53% after CR‐RT, 21% and 7% after IR, and 85% and 70% after IR‐RT, respectively (P < 0.0001). Survival rates at 3 years and 5 years and were 93% and 93% after CR, 90% and 90% after CR‐RT, 65% and 43% after IR, and 87% and 78% after IR‐RT, respectively (P = 0.0076). CONCLUSIONS Patients who underwent CR achieved better local control and survival rates compared with patients who underwent IR. After IR, patients appeared to benefit from RT. A beneficial effect of RT after CR was not observed. Cancer 2004;100:814–7. © 2004 American Cancer Society.

Women of different age treated with BCT for breast cancer should be considered at a different risk for HRQoL disturbance at long term F/U in both, physical and psychological dimensions. In clinical practice, specific identification of those women with negative impact of diagnosis and treatment on long term HRQoL would help for targeted interventions. In clinical studies focusing on HRQoL, the compared groups need to be age-adjusted.