Spinal cord astrocytomas: long-term results comparing treatments in children

Technology enabling radical resection has expanded treatment options for children with spinal cord astrocytomas. Comparison of long-term survival and neurological function after complete tumor removal with more conservative treatment may determine whether radical surgery can improve outcome in well-differentiated and anaplastic spinal cord astrocytomas. In all, 18 children with spinal cord astrocytomas were initially treated between 1976 and 1992 with biopsy in 6, subtotal removal in 7, and complete resection in 5. Seven had anaplastic tumors. Nine children treated before 1988 received radiotherapy. Survival after a median follow-up of 11 years was 82% (9/11). Five patients with anaplastic tumors are alive between 12 and 18 years after treatment. No patient relapsed after total resection, whereas more than two-thirds treated with other than complete resection relapsed within 3 years (P = 0.029). All but 1 patient with symptomatic relapse received radiotherapy (P = 0.059). Magnetic resonance imaging more than 3 years postoperatively showed no recurrences in 13 of the 15 survivors and asymptomatic progression in the other 2. Although excellent long-term survival was seen, frequent relapse was associated with either incomplete resection or radiotherapy. Prolonged relapse-free survival was observed in all patients treated with complete resection, including 3 with anaplastic tumors.