Early or Late Surgery for Supratentorial Gliomas? A Randomized Study

Abstract

The purpose of this study was to determine the value of sequential radiotherapy followed by cytoreductive surgery as compared with cytoreductive surgery followed by radiotherapy and chemotherapy in supratentorial malignant gliomas in adults. Since 1978 forty-seven patients were entered into this study and were randomly submitted to surgical procedure (early or late), whole-brain irradiation (6000 cGy) and chemotherapy with BCNU (80 mg/sqm/ iv × 3 days). Twenty-five patients were assigned to the control arm (early surgery) and 22 to the late surgery arm. The results demonstrate no statistical difference in survival or in recurrence time between patients treated with early or late surgery. Toxicity was similar among the two groups but late-surgery patients had a better quality of life. Late surgical procedure appears safe and feasible. The tumor was often necrotic and well demarcated from surrounding brain and therefore often easily removed. Late surgery might be a treatment of choice for tumors with poor surgical indications.