Treatment and Survival of Low-Grade Astrocytoma in Adults--1977–1988

Abstract

A retrospective review of the records of the Division of Neuropathology at the New York University Medical Center between 1977 and 1988 revealed 53 cases of adult supratentorial astrocytomas. Fifty were fibrillary, and three were gemistocytic. Two additional patients had pilocytic tumors and were not included in the study. The majority of patients had either a subtotal (64%) or gross total resection (19%). Biopsy (17%) was performed for deep-seated lesions and for those lesions confined to eloquent cortex. Forty-eight patients (91%) received postoperative radiation therapy. The median survival was 7 1/4 years with a 5-year survival of 64%. Multivariate regression analysis demonstrated that the most important prognosticators for improved survival were young age, absence of contrast enhancement of the original tumor on computed tomography (CT) and the performance status of the patient. Patients with hemispheric tumors died from dedifferentiation into an anaplastic astrocytoma or a glioblastoma multiforme, with a median time to recurrence of 4.5 years from the original surgery. Survival from the time of recurrence was 12 months. Subsequent operations confirmed progression towards malignancy in six of seven (86%) recurrent tumors. CT contrast enhancement of the original tumor was associated with a 6.8-fold increase in risk for later recurrence. Patients with thalamic tumors (six patients) had a poor prognosis with a median survival of less than 2 years. A review of their CT scans suggest that four died of progressive low-grade disease; however, confirmatory autopsy data were available for only one patient. This study supports others that have shown improved survival for adult patients with astrocytomas treated in the CT era.

Positron emission tomography11C-methionine and survival in patients with low-grade gliomas

“…In some studies, patients with a lack of contrast enhancement have shown a prognostic benefit. 5,34 Because contrast enhancement was not at all significant in the survival analysis in this study (P-to-enter ϭ 0.82), and no interaction could be demonstrated between the variables in the Cox analysis, the prognostic value of the MET uptake cannot be explained by the association between PET and contrast enhancement.…”

“…It has been assessed that 49 -85% of low-grade astrocytomas undergo transformation to a higher grade at some point along the course. [3][4][5] Malignant transformation occurs also in low-grade oligodendrogliomas. 6 Therefore, it is reasonable to assume that an early malignant transformation is responsible for the short survival in some of these patients.…”

Supratentorial World Health Organization Grade 2 astrocytomas and oligoastrocytomas

“…Thus, the prognostic relevance of tumor volume could be attributed either to the therapy is in accordance with the results of the current series (63% males). 3,7,18 or the biology of the tumor. In the current study the influence of treatment-related effects was minimized.…”

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“…Havendo evidências de progressão da lesão, ou agravamento do estado neurológico, a exérese da lesão deve ser realizada. Idade inferior a 40 anos associase a prognóstico favorável 144 .…”

“…Astrocitomas de tronco encefálico costumam apresentar prognóstico pior 183 . Influencia também a sobrevida dos doentes, a malignização das lesões 144 . Características radiológicas, histológicas e doses de radioterapia interferem na evolução, mas não foram avaliados durante a realização do presente estudo 183 .…”