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Management and Outcome of Recurring Low-Grade Intramedullary Astrocytomas.
Elly Chaskis1, Martina Silvestri1,2, Nozar Aghakhani1,2
1Department of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, France.
Cancers
|July 13, 2024
Summary
Complete surgical resection, not tumor grade, is key for low-grade intramedullary astrocytomas (LG-IMAs). Management of recurring LG-IMAs remains variable with no clear best approach.
Area of Science:
- Neurosurgery
- Oncology
- Neuropathology
Background:
- Intramedullary astrocytomas (IMAs) are the second most common intramedullary tumors in adults.
- Low-grade IMAs (LG-IMAs) have a better prognosis than high-grade IMAs (HG-IMAs).
- Adjuvant treatment and recurrence management for LG-IMAs are controversial.
Purpose of the Study:
- To evaluate the postoperative outcomes of LG-IMAs.
- To assess the management strategies for recurring LG-IMAs.
Main Methods:
- Retrospective review of 40 patients operated on for IMAs between 1980 and 2022.
- Analysis included 30 LG-IMAs and 10 HG-IMAs.
- Focus on extent of surgical resection, adjuvant therapies, recurrence patterns, and survival rates.
Main Results:
- 53.3% of LG-IMAs recurred over a median follow-up of 59 months.
- Large resections (gross total or subtotal) were associated with better overall survival (OS) and progression-free survival (PFS) (p=0.04 for PFS).
- No significant difference in OS or PFS between WHO grade I and II tumors; recurrence management was highly variable.
Conclusions:
- Extent of surgical resection (gross total or subtotal) is the primary prognostic factor for LG-IMAs, not WHO grading.
- Adjuvant treatments (radiotherapy/chemotherapy) were primarily used for biopsy cases.
- Management of recurring LG-IMAs lacks conclusive evidence for optimal treatment strategies.
