Fisher PG et al. – Long-term overall survival (OS) is excellent for pts with low-grade astrocytomas (LGAs), particularly pilocytic astrocytomas (PAs); although tumor location and resection extent affect outcome, pathologic diagnosis significantly influences long-term survival; immediate postoperative irradiation offers no advantage in delaying first progression in children with residual PA Methods
Study of long-term natural history of LGAs in children in terms of pathology and treatment effect on survival
Review of a consecutive cohort of pts from 1965-1996 with surgically confirmed LGA
All pathology specimens reviewed and masked to original diagnosis, pt data, and neuroimaging
Results
Of 278 children, 160 were male; mean age 9.1 yr; tumor location: 77 cerebrum, 62 cerebellum, 51 hypothalamic, 30 thalamus, 9 ventricle, 40 brainstem, 9 spine
OS for all LGA 5 and 10 yr after initial surgery: 87% and 83%; progression-free survival (PFS): 55% and 42%, respectively
Original pathology diagnoses did not predict PFS; reviewed diagnoses were significantly associated with PFS
Reviewed diagnoses were highly associated with OS; 5-year OS for PA was 96%, DA 48%, NOS 86%; differences remained significant when stratified by location or resection extent
In pts with residual tumor post-surgery, 5-year PFS with observation alone did not differ from that with immediate irradiation
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