Long-term survival and recurrence-free interval in combined surgical, radio- and chemotherapy of malignant brain gliomas.

A prospective randomized study has been conducted since 1978 to judge the value of combined radio- and chemotherapy (CCNU) in the postoperative treatment of grade III and IV supratentorial gliomas. Inoperable or recurrent tumors were excluded from these series, but evaluated in addition. Increase in median survival time (18 months) for the entire series (62.2% glioblastomas) was only small compared to other series mentioned in literature, but there was a significant prolongation of the recurrence-free interval (16.5 months) and in the total survival time from the onset of symptoms in 46.4% of cases living more than 18 months. If 'useful recovery' is the major goal of present treatment of cancer, the recurrence-free interval and the fraction of long-term survivors may be more important statistical parameters than median survival time. To improve the 'quality of life' in a number of patients (so-called long-term survivors) and the length of recurrence-free intervals should be the therapeutic goal, even if overall survival time remains essentially unaffected. We conclude that combined therapy, including radio- and chemotherapy, following surgical resection is of value in most cases of malignant glioma.