Late results of multimodality therapy of high-grade supratentorial astrocytomas.

Fifty-one patients with histologically proved astrocytomas grades III and IV treated with postoperative irradiation and chemotherapy were evaluated with serial computerized tomographic (CT) scans and with special regard to their functional state 30 months after operation. Fourteen patients (27.4%) are still alive, but only 7 of them have a good performance status. The impaired functional state of 6 (11.7%) of the other 7 patients was caused by a secondary progressive dementia with radiological signs of diffuse cerebral atrophy and leukoencephalopathy, but no signs of recurrent tumors. The best explanation for this is a synergistic toxic action of whole brain irradiation and chemotherapy. Measuring survival time for evaluation of brain tumor therapy is of limited value without examination of the performance status and sequential CT scans.