Prognostic Factors for Cerebellar Astrocytomas in Children: A Study of 102 Cases

Abstract

Objective: To evaluate the prognostic factors influencing the length of survival of pediatric patients with cerebellar astrocytomas. Methods: The clinical data of 102 patients under the age of 12 years with cerebellar astrocytomas were retrospectively analyzed. The radiological features, surgical findings, histology and adjuvant radiotherapy were reviewed. Patients were followed up on an outpatient basis. Computerized tomography (CT) scans of the brain were performed to detect recurrence. Results: The age of the patients at presentation varied from 10 months to 12 years. The mean age at presentation was 7 years and 11 months. The average duration of symptoms was 5.8 months. The clinical features were predominantly related to intracranial hypertension and the location of the tumor. Twenty-six tumors were located in the vermis and 76 in the cerebellar hemisphere. The brain stem was involved in 20 patients. All 102 patients had a preoperative contrast-enhanced CT scan. Midline vermian tumors were predominantly solid and enhancing, whilst the hemispheric tumors were cystic and nonenhancing. The tumors were graded into three subgroups based on histological characteristics: pilocytic astrocytoma, low-grade fibrillary astrocytoma and high-grade fibrillary astrocytoma. Total, radical and subtotal excision, as determined by the surgical impression, were performed in 82, 16 and 4 patients, respectively. Postoperative radiotherapy was administered to 12 patients. CSF diversion was carried out in 11 of 79 cases who had moderate to severe hydrocephalus. Conclusions: Our study has shown that the location of the tumor (p < 0.05), histological grade (p < 0.001) and the extent of tumor resection (p < 0.001) have a significant and definitive relationship to the length of survival of pediatric patients with cerebellar astrocytomas. The patient’s age (p > 0.05) does not influence the outcome. We could not evaluate the effect of brain stem involvement and adjuvant radiotherapy in our study because of the small sample size.

Surgical Outcomes of Cerebellar Tumors in Children

“…Of these, 13 (93%) were pilocytic and 1 was a grade-III fibrillary astrocytoma. Although total tumor removal has a great effect on the outcome of surgery [8], the morbidity associated with gross total removal of pediatric posterior fossa tumors is well recognized [9]. Although the extent of surgical resection did not significantly influence prognosis, total resection should be done at the initial craniotomy.…”

Outcome of children with centrally reviewed low‐grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high‐grade glioma study CCG‐945

“…Similarly, a number of studies have indicated that patients who have JPA have a survival advantage compared with patients who have FA. 34,[42][43][44][45][46] In contrast, in a study of 142 children with low-grade astrocytoma, Gajjar et al 33 found no relation between tumor histology (JPA vs. astrocytoma, not otherwise diagnosed) and PFS in an analysis that controlled for age and anatomic site.…”

Residual or Recurrent Cerebellar Low-Grade Glioma in Children after Tumor Resection: Is Re-Treatment Needed? A Single Center Experience from 1983 to 2003

“…By far the most important predictor of prognosis in patients with LGG is complete tumor resection. Patients who underwent a less than gross total resection have an increased risk to develop disease progression and a decreased overall survival [3,4,5,7,8,9,10,11]. To assess the requirement and frequency of re-treatment in patients with residual or recurrent cerebellar LGG after tumor resection, we performed a retrospective data analysis of all children with cerebellar LGG treated at our institution between 1983 and 2003.…”