Low Grade Astrocytoma (LGA)
In a large retrospective study of LGA
- 83% 10-year overall survival (OS)
- Improved survival
- Pilocytic astrocytoma (vs DA)
- hemispheric tumor location
- greater extent of resection
There was a continued risk for first relapse or death more than 10 years after
Stable disease demonstrated after 5 years in nearly half of patients whose LGA was incompletely removed
Juvenile pilocytic astrocytoma:
- Amenable to complete resection and cure
- Extent of surgical resection is strongest predictor of outcome
- Gross total resection has the greatest survival rate
- Following an incomplete resection the patient’s 5 yr progression free survival is 60% with a 10 yr overall survival of 85%
Cerebellar tumors have the best prognosis, due to the amenability of this area to complete surgical resection.
Hypothalamic lesions are not amenable to gross total excision
Optic nerve tumors have an intermediate prognosis.
High Grade Astrocytoma (HGA)
The outcome of children with high-grade gliomas is generally poor (Chastagner et al).
Overall survival rates are generally in the range of 15 – 20%.
With the combination of surgery and radiotherapy, only a few patients survive beyond 5 years after diagnosis.
Factors that improve outcome are:
- Complete tumor resection:
- In the CCG-945 study, radical tumor resection was the only therapeutic variable that significantly improved event free survival rates and this was also demonstrated in French and German studies.
- Grade 3 pathology:
- Children with anaplastic astrocytoma have a better prognosis than those with glioblastoma multiforme.
- Patients with grade III tumors survive longer than those with Grade IV tumors.
- Few patients with grade IV survive beyond 2 years and 30 - 40% of grade III patients survive 3 - 5 years.