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Low grade astrocytoma in children treated by surgery and radiation therapy
Insights
Surgery and postoperative irradiation offer high survival rates for pediatric low-grade astrocytoma. Complete tumor removal may negate the need for radiation, while it appears beneficial for subtotally resected cases.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Radiation Oncology
Background:
- Low-grade astrocytoma is a common pediatric brain tumor.
- Treatment strategies involve surgery and/or radiation therapy.
- Optimizing outcomes while minimizing long-term effects is crucial.
Purpose of the Study:
- To retrospectively analyze the outcomes of surgery and postoperative irradiation in children with low-grade astrocytoma.
- To evaluate the impact of tumor characteristics and extent of resection on survival and relapse.
- To assess the role of postoperative irradiation in different surgical scenarios.
Main Methods:
- Retrospective analysis of 35 children under 15 years old treated for low-grade astrocytoma.
- Evaluation of overall survival and relapse-free survival using actuarial methods.
- Comparison of outcomes based on sex, tumor consistency (cystic vs. solid), and extent of surgical resection.
Main Results:
- Actuarial 5- and 10-year overall survival rates were 94% and 82%, respectively.
- Actuarial 5- and 10-year relapse-free survival rates were 87% and 70%, respectively.
- No relapses occurred in completely resected tumors (10 cases), suggesting potential for omitting radiation in this subgroup. Postoperative irradiation appeared beneficial in subtotally resected cases (24 patients).
Conclusions:
- Surgery and postoperative irradiation provide favorable survival rates for pediatric low-grade astrocytoma.
- Complete tumor resection may allow for observation without adjuvant radiation.
- Radiation therapy seems beneficial for subtotally resected tumors to prevent local recurrences.
Abstract:
Results of treatment of low grade astrocytoma by surgery and postoperative irradiation in 35 children under 15 were retrospectively analysed. The actuarial overall 5 and 10 year survival was 94 and 82 per cent, the actuarial relapse-free survival 87 and 70 per cent, respectively. The male patients fared better, although not significantly, than the females. No significant difference in relapse rate was found between cystic and solid tumors. The cystic processes had a more indolent course, but a fatal outcome was noted in one case (after 21 years). No relapse occurred in totally removed tumors (10 cases), which throws doubt on the need for postoperative irradiation in this subgroup. In the subtotally resected processes (24 cases) radiation therapy seemed to be beneficial, as in 3 of 4 local recurrences geographic misses of tumour remains probably existed. No dose response relationship was apparent. The performance status was severely impaired in 11 per cent (3/27 patients). Growth retardation was observed in 2 patients.