Treatment Results and Prognostic Variables of Supratentorial Low-grade Astrocytomas which were Treated with Radiation Therapy Following Incomplete Resection in Adults.

Chang, Chul Hoon; Kim, Jung Hoon; Kwun, Byung Duk

Original Article

Journal of Korean Neurosurgical Society 1997;26(1): 71-81.

Chul Hoon Chang, Jung Hoon Kim, Byung Duk Kwun

Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

ABSTRACT

The natural history of low-grade astrocytomas is variable. Although many patients survive for an extended period of time, other patients have a rapidly progressive course and early death. In order to determine the specific prognostic factors in low-grade astrocytoma(LGA) patients with uniform contemporary technique, data from 41 consecutive supratentorial LGA patients(>or=18 years of age) treated with radiation therapy following incomplete resection between June 1989 and May 1993 at our hospital were analyzed. Variable factors were examined for their association with survival: age at the time of diagnosis, gender, length and type of neurological symptoms, preoperative neurological status, contrast enhancement pattern on CT, and extent of the lesion as defined by CT/MRI. The following characteristics were associated with improved patient survival by univariate analysis(p<0.05): onset of symptom to treatment >12 months, and seizure as a presenting symptom at the time of admission. Other factors were not significant in determining the length of survival. Overall acturial survival at 3 and 5 years was 82% and 70%, respectivley. Nine of these 41 patients had tumor recurrences/progressions with a mean time of 20.6 months. Among 9 tumor recurrences/progressions, second surgery was perfomed in 5 patients and 3 of these 5 patients had progressed to high-grade lesions(2 glioblastoma multiformes, 1 anaplastic astrocytoma). Seven patients died from tumor progression/recurrence. Concerning surgical removal, an attempt should be made, whenever possible, for a gross total resection. But, when that is not possible, we think that biopsy or partial debulking without undue risk of significant neurologic compromise followed by radiation therapy can serve as an alternative treatment option in supratentorial LGAs.

Key Words: Low-grade astrocytoma; Prognostic factors; Survival; Recurrence; Surgery; Radiation therapy