The efficacy of radiotherapy for craniopharyngioma

A series of 125 patients who underwent surgery for craniopharyngiomas was evaluated to assess the efficacy of radiation therapy: 45 patients had received radiotherapy and 80 had not. These patients included all operative survivors (excluding cases with total tumor removal) treated during the 30 years from 1950 to 1979. Median survival time of the irradiated group was greater than 10 years, whereas it was 3.12 years for the nonirradiated (or control) group. The 5- and 10-year survival rates were 88.9% and 76.0% for the irradiated group, and 34.9% and 27.1% for the control group, respectively. Overall comparison, using the Lee-Desu statistical method, revealed that there was a very high statistical significance (at the level of p less than 0.0001) in the difference between the survival times of the irradiated and control groups. The influence of the following factors on the effectiveness of radiotherapy was analyzed: age of the patient at the first operation, sex, date of surgery, the extent of tumor removal, the size of the tumor, the composition of the tumor (cystic or solid), whether the tumor was calcified or not, the histological subtype of the tumor, the presence of intracranial hypertension, the grade of visual failure, and the presence or absence of diabetes insipidus, altered mentation, and adiposogenital syndrome. The results indicated that, when total removal of the tumor is impossible, radiotherapy should be administered.     

Craniopharyngioma in adults and children: a study of 122 surgical cases

OBJECT: This work is devoted to a 25-year retrospective study of 122 cases of craniopharyngiomas in adults and children treated and followed by the same neurosurgeon (R.V.E.). In this homogeneous series, the aim was total microsurgical removal of the tumor, without postoperative radiotherapy. METHODS: The operation was performed via a frontopterional approach in 112 cases and a transsphenoidal approach in 10 cases. The tumor removal was considered total in 59%, subtotal in 29%, and partial in 12%. The surgical mortality rate was 2.5%. Even when tumor removal was not complete, radiotherapy was not systematically administered; it was reserved for cases of recurrence. The authors have studied clinical signs, operative characteristics, and ophthalmological, endocrinological, and functional outcomes, as well as recurrence risk and long-term patient survival. The mean follow-up period was 7 years. The functional results in these patients were excellent in 85%, good in 9%, fair in 5% (usually because of ophthalmological sequelae), and poor in 1%. Tumors recurred in 29 patients, but the salvage treatment, by operation or radiotherapy, was successful in 83%. The actuarial patient survival rate was 92% after 5 years and 85% after 10 years. CONCLUSIONS: These results compared favorably with the data reported in the literature, suggesting that radical surgery of craniopharyngiomas allows good outcome in terms of survival, full recovery, and quality of life for both adults and children.     

Management of nonfunctioning pituitary adenomas with suprasellar extensions by transsphenoidal microsurgery.

BACKGROUND: We evaluated the feasibility and therapeutic effectiveness of transsphenoidal microsurgical removal of nonfunctioning pituitary adenomas with suprasellar extensions. The diagnostic modes, surgical technique, and outcome were reviewed in 208 patients with pituitary adenomas extending beyond the sella turcica who were treated by transsphenoidal microsurgery. All patients except three presented with significantly diminished visual acuity and visual field defects. METHODS: Diagnosis was confirmed by skull X-ray plain films, CT, or MRI scanning. Operations were performed via a transsphenoidal approach under microscope. A subarachnoid catheter was preoperatively inserted in the lumbar cistern, through which saline was slowly injected during operation to increase the intracranial pressure so as to move the suprasellar tumor into the operative field to aid the removal. RESULTS: In this series, gross total removal of an adenoma in 146 cases (70.2%) and subtotal removal in 50 cases (24.0%) was achieved; partial removal was carried out in the remaining 12 cases (5.8%) of fibrous or dumbbell-shaped adenomas. There were no deaths in this group. Follow-up review (median 3.8 years) in 187 patients revealed that 97.8% of those with preoperative diminished visual acuity had postoperative improvement; 2.2% had no change, and none deteriorated significantly. Among 181 patients with preoperative visual field defects, postoperative improvement was good in 169 (93.4%), and poor in 12 (6.6%). The major complications were diabetes insipidus and cerebrospinal fluid rhinorrhea, which occurred in 13.5% and 4.8% of patients, respectively. The tumors recurred in 12 patients (6.4%) who were considered to have a macroscopically complete removal at surgery. Continuing growth of residual tumors was found in 31 (16.6%) based on visual acuity decrease, visual field defects, and CT or MRI examination. Of the recurrent and residual tumors, 4, 9, 17, and 13 cases belonged to Grades A, B, C, and D, respectively. CONCLUSIONS: Comparison with transfrontal surgery suggests that these results are as good as those of transfrontal procedures and that the incidence of serious side effects is considerably lower. We consider that the microsurgical removal of pituitary tumors by the transsphenoidal approach is safe and effective even in very large or giant adenomas, since it allows rapid and adequate decompression of the optic nerves and chiasm.     

Radiofrequency capacitive hyperthermia combined with irradiation of chemotherapy for patients with invasive bladder cancers

To assess the immediate therapeutic clinical efficacy and long-term outcome, hyperthermia in combination with irradiation or chemotherapeutic agent was used in 46 patients with invasive bladder cancer. Radiohyperthermia (RH) was employed in 19 cases and chemohyperthermia (CH) in 27 cases. Complete response (CR) was obtained in 5 and partial response (PR) in 15 of the 46 cases. One-year survival rates by the Kaplan-Meier method were 65.0% in the CR/PR group and 46.2% in the no change (NC)/progressive disease (PD) group. Five-year survival rates were 43.8% and 18.3%, showing no difference in survival rate between the CR/PR group and the CN/PD group. The overal median survival period for the CR/PR group without metastasis was 61.6 months compared to 32.3 months for the NC/PD group without metastasis (P<0.05).     

经单鼻孔-蝶窦入路垂体腺瘤显微手术治疗及其策略

目的 总结采用经单鼻孔-蝶窦入路显微手术治疗垂体腺瘤的临床疗效.方法 从2003年1月至2007年12月,经单鼻孔-蝶窦入路显微手术治疗垂体腺瘤241例,并对其临床表现、肿瘤病理、肿瘤切除率、术后并发症进行总结分析.结果 垂体腺瘤241例中,全切除171例(71%),次全切除28例(11.6%),大部分切除26例(10.7%),部分切除16例(6.6%).术后多饮、多尿38例(15.8%)、术后视力一过性下降12例(4.9%)、术后脑脊液漏4例(1.6%)、一侧动眼神经损伤2例(0.8%),无死亡病例.除动眼神经损伤的2例外,其余病例的术后并发症在出院时已治愈.随访1-36个月,所有病例的临床症状均有不同程度改善.结论 经单鼻孔-蝶窦人路显微切除垂体腺瘤手术时间缩短,创伤小,手术效果好.     

Treatment of oligodendrogliomas with or without postoperative irradiation

The authors have reviewed the treatment results in 42 patients with intracranial oligodendroglioma treated from 1940 through 1983 at the University of California, San Francisco. Two patients who died postoperatively were excluded from analysis. Eleven patients had mixed tumors, with a minor astrocytic component. The overall survival rates for the 29 patients with pure oligodendroglioma were 61% and 33% at 5 and 10 years, respectively; these rates for the 11 patients with mixed tumors were 57% and 38% at 5 and 10 years, respectively. The 10-year survival rate for 14 patients with pure oligodendroglioma who received greater than 45 Gy irradiation was 56% versus 18% for 11 patients who did not receive postoperative irradiation (p = 0.09). Nine patients with mixed tumor who received more than 45 Gy postoperatively had survival rates similar to those for the 14 patients with pure tumors irradiated with more than 45 Gy (p = 0.89). All patients who died of their tumor had evidence of intracranial recurrence. One patient, who did not receive initial postoperative irradiation, also had clinical and myelographic evidence of spinal seeding. All five patients examined postmortem had tumor recurrence at the primary site; one patient also had intraventricular seeding. Six of the 10 patients with pure oligodendroglioma who had a repeat biopsy at the time of tumor recurrence or at postmortem examination showed histological progression to an anaplastic astrocytoma or glioblastoma multiforme. Based on this study, adult patients with pure or mixed oligodendroglioma currently are treated with partial-brain irradiation to a dose of about 60 Gy. In general, children are treated with partial-brain irradiation to about 50 Gy.     

Results of the surgical treatment of metastatic brain tumors

Results of surgical treatment in 85 cases with metastatic brain tumors are reviewed. The lung was the most frequent site of primary lesion and the following sites were GI tract and the breast. Adequate treatment consisted of total removal of tumor, irradiation and/or chemotherapy were carried out in 51 cases. The remaining 34 cases had an unsuccessful treatment because of their poor physical condition. Mean survival time after adequate treatment was 8.75 months in the former group and 3.06 months in the latter group. Of 51 patients (86.3%) in the former group, 44 showed improvement of the neurological signs after treatment. In the latter group, only 14 patients (41.2%) revealed neurological improvement. Total removal of tumor was carried out in 55 of 85 cases. The one-month operative mortality for all patients was 19.2%. Postoperative one-year survival rate was 12.5% in 16 cases with multiple metastases and in 36 cases with single metastasis was 25.6%. Follow-up study of 77 cases showed 31.2% of survival rate in 6 months, 18.2% in one-year and 5.2% in two-years. Only four patients survived more than 3 years after treatment. The direct causes of death in cases of total removal were attributed in recurrence of primary lesion or remote metastases to other organs. This study revealed that the prognosis of the patient with metastatic brain tumor was influenced by existence of intracranial hypertension due to brain edema or metastatic tumor itself and metastases to other organs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Statistical analysis of clinicopathological features, radiotherapy, and survival in 170 cases of oligodendroglioma

The postoperative survival time of 170 nonrandomized patients treated for cerebral oligodendrogliomas in Norway from 1953 to 1977 was studied. Survival times were significantly prolonged if postoperative irradiation was performed in addition to surgery (median survival time 26.5 vs. 38 months, p = 0.039). In the group without postoperative radiotherapy, the 5-year rate of survival was 27% compared with 36% in the irradiated patients. The respective survival rates after 8 years were 14% versus 17%; thus, there was little effect on long-term survival. Irradiation appears not to be of benefit after "total" removal. Patients with partly resected lesions appeared to benefit from postoperative radiotherapy; the median survival period after subtotal tumor resection was 37 months with and 26 months without radiotherapy (p = 0.0089). The findings also indicate that irradiation doses between 40 and 50 Gy were as effective as doses between 50 and 60 Gy in increasing the patients' probability of surviving 5 years after subtotal tumor resection. Since the risk of radiation necrosis is proportional to the dose applied, the lower dose is recommended. These conclusions were also valid when adjustments were made for prognostically significant histological and clinical features.     

经蝶入路显微外科切除颅咽管瘤适应证选择与操作要点

有关颅咽管瘤的手术一直是神经外科医师最感困惑的问题。本文报道经蝶显微手术切除颅咽管瘤18例,均经CT或MRI扫描确诊。本入路适用起源于鞍底或向鞍上扩展的肿物。手术采取经唇下-鼻中隔-蝶窦入路或经鼻前庭-鼻中隔-蝶窦入路两种方式行肿瘤切除术。9例肿瘤获得全切除,4例次全切除,其余5例为部分切除,术后无死亡。15例获长期(平均3.1年)随访,有12例(80.0％)恢复良好,3例影像学检查提示肿瘤复发,需行再次手术,放疗或放射外科治疗。文中对颅咽管瘤手术适应证选择及操作要点进行了讨论。     

Primary intrasellar germinoma presenting with cavernous sinus syndrome

A 28-year-old woman, 1 month post partum, who presented with headache and gradual onset of total ophthalmoplegia of the left eye, was found at transsphenoidal exploration to have a primary intrasellar germinoma. Craniospinal irradiation resulted in complete resolution of the intracranial tumor. Extensive mediastinal metastasis at 8 months after the operation resulted in a fatal outcome.     

Myxopapillary ependymoma of the filum terminale and cauda equina in childhood: report of seven cases and review of the literature

Seven of fourteen children with spinal cord ependymoma had myxopapillary tumors of the filum terminale. These tumors made up 15.9% of all primary spinal neuroectodermal tumors in children (44 cases) seen during a 62-year period (1919 to 1981). Their clinical presentation, radiological features, pathological findings, treatment, and outcome are reported. Six of the seven patients were known to be alive at the time of writing. The seventh patient was lost to follow-up after 3 years without tumor recurrence. Of 5 patients whose primary mode of treatment was operation alone. 3 had intraspinal or intracranial recurrences. Despite tumor recurrences, 2 patients were long term survivors after further operation and irradiation, whereas the third patient recently received craniospinal irradiation for intracranial tumor recurrence. The 2 patients who did not have tumor recurrence after operation alone had been followed for 3 and 7 years, respectively. Two children with subtotal tumor resection and spinal irradiation had no recurrences at 1 and 17 years, respectively. Our data suggest that this unusual subtype of spinal ependymoma is not uncommon during childhood and has a good prognosis. All patients with this tumor require prolonged follow-up for tumor recurrence after operation and irradiation.     

蝶窦入路切除垂体腺瘤后患者视力障碍恶化的原因及防治

目的：探讨经蝶窦入路切除垂体腺瘤后视力障碍恶化的原因和防治方法。方法：对采用经蝶窦入路切除垂体腺瘤,术后出现视力障碍恶化的14例患者的临床资料（病史、临床表现、影像学结果及手术所见)进行回顾分析。结果：本组患者出现视力障碍恶化的原因,5例为临床填放物过多、3例为残瘤卒中、2例可能为血管痉挛、2例为颅内压增高、1例为视神经管内视神经受损、1例原因不明。结论：经蝶窦入路切除垂体腺瘤,术后患者视力障碍恶化是垂体腺瘤手术的严重并发症,及时发现和早期治疗可以显著改善患者视力。     

经蝶入路显微外科切除颅咽管瘤

目的　为探求一种颅咽管瘤切除的手术径路可能性。　方法　回顾总结１８ 例颅咽管瘤的诊断方式,手术技巧和治疗结果,均经 Ｃ Ｔ 或 Ｍ Ｒ Ｉ扫描确诊。手术采取经唇下蝶窦入路或经鼻前庭鼻中隔蝶窦入路两种方式行肿瘤切除术。　结果　９ 例肿瘤获全切除,４ 例次全切除,余５ 例为部分切除,术后无死亡。１５ 例获长期随访（ 平均３１ 年） ,有１２ 例恢复良好。　结论　对位于鞍内的颅咽管瘤或肿瘤系囊性并向鞍上扩展者,采用经蝶入路显微手术切除是一种安全、有效的方法     

大型垂体腺瘤经蝶显微外科治疗技术要点

报道经蝶显微手术治疗大型垂体腺瘤145例,均经CT扫描或MRI确诊,肿瘤向鞍上扩展直径>10mm。在手术显微镜下经唇下—鼻中隔—蝶窦入路或经鼻前庭—鼻中隔—蝶窦入路两种方式行肿瘤切除术。术中于腰蛛网膜下腔予置一导管,用于注射生理盐水,增加颅内压力,使鞍上瘤块进入手术野,以利切除。102例(70.4％)肿瘤获全切除;35例(24.1％)达次全切除;余8例(5.5％)系哑铃型或纤维性腺瘤,行部分切除。术后无死亡。132例平均随访观察3.5年,其中93例(70.5％)恢复良好,39例(29.5％)肿瘤复发,需再次手术,或采用药物、放疗或放射外科治疗。文中对本型肿瘤经蝶显微外科处理的方法与技术要点进行了讨论。     

Role of transsphenoidal operation in the management of pituitary adenomas with suprasellar extension

Summary 59 consecutive patients with suprasellar extending pituitary adenomas were operated on by the transsphenoidal approach. The suprasellar tumour extension was in 30 cases stage A (Hardy-Wilson), in 18 stage B and in 11 stage C. 14 patients were above 65 years of age and in this latter group 9 cases had large tumours (B or C). 78% of endocrinologically active tumours did not reach the chiasm (stage A) whereas 72% of functionless adenomas compressed the chiasm or grossly the third ventricle. Visual field defects and loss of visual acuity was both present in roughly 90% of stage B and C tumours. Radical surgical removal with regard to suprasellar extension was possible in all but 6 cases. Four of these patients had tumour remnants large enough to require removal by a second intracranial operation. No patient developed visual deterioration post-operatively. Pre-operative visual dysfunction was normalized or markedly improved in more than 90% of the cases. Failure to normalize vision was closely linked to the presence of pale optic discs. Pre-operative hypersecretion was normalized in 70% of the cases. Addition of permanent pituitary insufficiency occurred in three patients.     

内镜辅助经鼻蝶入路至斜坡区的显微手术

目的 探讨内镜辅助经鼻蝶入路至斜坡区的显微手术方法和疗效.方法 根据经鼻蝶入路至鞍区斜坡区显微解剖学研究结果,采用内镜辅助经鼻蝶显微手术治疗该区肿瘤12例(侵袭性垂体腺瘤8例,脊索瘤3例,软骨瘤1例).所有病例均在3个月至6年内获得随访.结果 手术全切8例,次全切除3例,部分切除1例.术后发生短暂性尿崩症6例,脑脊液鼻漏2例,无死亡及颅内感染.随访3个月至6年,除1例脊索瘤残瘤继续生长外,其余患者未见肿瘤复发.结论 采用经蝶入路显微手术切除沿中线生长的鞍区斜坡区肿瘤,入路简便快捷,创伤小,手术显露良好,疗效满意.内镜辅助使得经蝶入路更为安全、有效.     

The role of transsphenoidal surgery in the treatment of craniopharyngiomas

OBJECT: The optimal approach for the surgical treatment of craniopharyngiomas is still debated. In all cases involving the sella turcica, the authors have exclusively used transsphenoidal surgery (TSS), assuming that this approach is less traumatic than an intracranial one. Moreover, TSS was also performed in some cases of purely suprasellar craniopharyngiomas. In this study the surgical indications and the results obtained in all patients who had undergone TSS were analyzed. METHODS: In a series of 92 patients who underwent surgery for craniopharyngiomas, TSS was the first choice of approach in 57 cases (62%) consisting of 29 female and 28 male patients with ages ranging from 12 to 79 years (mean 35 years). The follow-up duration ranged from 2 to 20 years. A standard transsphenoidal approach was used in patients with an exclusively intrasellar (11 patients) or an intrasellar and suprasellar tumor (37 patients); in nine cases of tumors located exclusively above the sella turcica, a transsphenoidal presellar approach (seven patients) or a transsellar-transdiaphragmatic approach (two patients) was used. Total removal was performed in 36 patients (63%). All patients had good clinical results. Postoperative cerebrospinal fluid leakage occurred in 10 cases, but only one case required a surgical repair of the sella. Two patients died of late complications (3.5%). There were eight cases (14%) of tumor regrowth. CONCLUSIONS: The authors assert that, when used in appropriately located craniopharyngiomas and by neurosurgeons with extensive experience in pituitary surgery, TSS offers excellent results with minor risks.     

超声刀和钳夹法在经肝门板半肝阻断术中的应用及远期预后比较

目的 探讨超声刀和钳夹法在经肝门板半肝阻断术中的应用及远期预后比较。方法 回顾性分析2007年3月至2010年12月在我科采用经肝门板半肝阻断法行手术切除,术后经病理证实为肝细胞癌的98例患者临床资料,根据肝实质断离术分为超声刀组（52例）和钳夹法组（46例）,观察两组术中指标、肝功能以及术后并发症,采用Kaplan-Meier法分析患者5年生存状况。结果 超声刀组在手术时间、术中出血量、术中需要输血的患者数、谷丙转氨酶水平恢复时间、术后总胆红素以及术后凝血酶原时间方面均显著低于钳夹法组（P<0.05）;超声刀组术后住院时间短于钳夹法组（P<0.05）;各并发症的发生率、胃肠功能恢复时间以及腹腔引流时间两组无统计学差异（P>0.05）;钳夹法组和超声刀组1年、3年、5年的总生存率分别为93.7%、64.6%、26.2%和94.9%、69.2%、49.5%,差异有统计学意义（P=0.045）。钳夹法组与超声刀组1年、3年无肿瘤生存率分别为83.2%、58.6%和85.7%、59.3%,差异无统计学意义（P>0.05）,两组5年无肿瘤生存率分别为23.4%和46.2%,差异有统计学意义（P=0.039）。结论 在经肝门板半肝阻断术中应用超声刀治疗原发性肝细胞癌在手术时间、术中出血量、术后肝功能恢复方面优于钳夹法,术后随访显示患者5年的总体生存率、无肿瘤生存率高于钳夹法。     

神经导航在经蝶垂体腺瘤手术中的应用

目的 总结神经导航下经蝶手术治疗垂体腺瘤的经验,并讨论其适应证.方法 对2006年1月至2010年12月138例神经导航下经蝶垂体腺瘤手术病例进行回顾性分析.手术适应证包括:既往经蝶手术后复发性垂体腺瘤36例,侵袭型垂体腺瘤45例,位于垂体侧方或深部的微腺瘤45例,蝶窦气化不良4例,颅底异常增厚3例,双侧颈内动脉间距狭窄4例,鼻中隔偏曲1例.结果 复发性垂体腺瘤全切除12例,次全切除9例,术后出现瘤腔血肿2例,脑脊液漏4例,其中3例合并颅内感染,2例合并交通性脑积水,永久性动眼神经麻痹1例,垂体功能低下者3例;治愈9例,缓解8例.侵袭型垂体腺瘤全切除5例,次全切除27例,术后出现脑脊液漏并颅内感染1例,瘤腔血肿1例;治愈2例,缓解22例;侵袭型激素分泌型垂体腺瘤30例均未治愈缓解.微腺瘤45例均为激素分泌型,均全部切除,治愈38例.颈动脉间距狭窄4例和鼻中隔偏曲1例均全切除和治愈.蝶窦气化不良肿瘤全切除2例,次全切除2例,治愈1例.颅底异常增厚肿瘤全切除2例,次全切除1例,治愈1例.结论 神经导航可以使部分经蝶垂体腺瘤切除手术更加准确、安全、有效,在一定程度上扩大了经蝶手术的适应证.

Abstract：

Objectives To summarize the experiences in clinical application of neuronavigation in transsphenoidal microsurgery of specific pituitary adenomas, and to discuss its indications. Methods From January 2006 to December 2010,138 cases of transsphenoidal microsurgery for specific pituitary adenomas under neuronavigation were reviewed. The indications for neuronavigation in transsphenoidal microsurgery includes: recurrent or regrowth of residual pituitary adenomas after former transsphenoidal surgery in 36 cases, invasive pituitary adenomas in 45 cases, extremely laterally or deeply situated microadenomas in 45 cases, poor pneumatization of the sphenoid in 4 cases, skull base anomalies due to osteodysplasia fibrosa in 3 cases, narrow space between bilateral internal carotid arteries in 4 cases, distortion of nasal septum in 1 case. Results In the recurrence group, 12 were totally removed, 9 subtotally removed;postoperative complications included hematoma within the tumor cavity in 2 cases, cerebrospinal fluid (CSF) leakage in 4 cases among which 3 developed intracranial infection and 2 communicating hydrocephalus, oculomotor paralysis in 1 case and hypopituitarysm in 3 cases;9 were cured and 8 remission. In the invasive group, 5 were totally removed, 27 subtotally removed;postoperative complications included hematoma within the tumor cavity in 1 case, CSF leakage and intracranial infection in 1 case;2 were cured and 22 remission. None of the 30 invasive hormone-secreting adenomas were cured or remission. The 45 cases of hormone-secreting microadenomas were all totally removed, among which 38 were cured. Among the poor sphenoid pneumatization group, total and subtotal tumor removal were achieved in 2 cases respectively with only one cured. In the skull base anomaly group, 2 were totally removed and 1 subtotally removed, with only one cured. For the cases with narrow space between bilateral internal carotid arteries and distortion of nasal septum, all were totally removed and cured. Conclusions Transsphenoidal microsurgery under neuronavigation can be applied for pituitary adenomas in above specific indications. It is an accurate, safe and effective approach for specific pituitary adenomas, which can not only expand the indication of transsphenoidal microsurgery for pituitary adenomas, but also reduce the harmful exposure of X-rays for the operating staff.     

Results of supratentorial low-grade astrocytoma--effects of combined radiochemotherapy

The retrospective analysis of 53 cases with supratentorial low-grade (grade 1 or 2 due to WHO grading) astrocytomas included the years 1965-84. The 5-year and 10-year survival rates were 61.9% and 52.1%, respectively. The recurrence of tumors occurred in 15 cases (28.3%), almost within 3 years after the initial treatment, and early recurrent cases indicated poor results. Among them, 6 cases were noticed increasing malignancy of histological findings. According to our investigations, the factors which influence to the survival rate were age of patients, duration of symptoms before treatment, presence of neurological deficits and degree of surgical removal of tumor. The patients with good prognosis were under 20-year old, over 6 months of duration, with no neurological signs and with total or subtotal removal. But, 5-year survival rate was not so improved by postoperative radiation therapy. Analysis on the effects of chemotherapy for low-grade astrocytoma was little reported. We treated 26 patients with RAFP therapy (Radiation + ACNU + FT-207 + PSK). Only 2 cases out of 26 showed the recurrence till now. The rate of reduction of their tumors was 46.2% by CT scan. So, it was considered that RAFP therapy was effective for supratentorial low-grade astrocytoma.