PEDIATRIC ASTROCYTOMAS - THE LOUISVILLE EXPERIENCE - 1978-1988

Purpose: The purpose of this study is to retrospectively analyze all p ediatric patients with the diagnosis of astrocytoma treated either def initively or postoperatively in our department from 1978 through 1988. Grade, age, T-stage, tumor location, and extent of resection are indi vidually analyzed as prognostic indicators of overall survival. Materi als and Methods: Pediatric astrocytoma patients (grades I-IV) diagnose d by CT-guided biopsy or surgical resection were assessed. Patients we re treated with external beam radiotherapy to involved fields using 4- or 6-MV photons. Daily doses ranged from 1.5 to 2.0 Gy; total doses f rom 41.4 to 66 Gy. Treatment was given to 17 patients (9 male, 8 femal e), aged 18 years and younger: 11 patients had low-grade (I and II) as trocytoma with incomplete margins; 3 patients had anaplastic astrocyto ma; and 3 patients had glioblastoma multiforme. Results: Overall survi val at 140 months was 63%. Median follow-up of patients living NED was 69 months, with a range of 39-140 months. Nine of the eleven (82%) lo w-grade patients survived NED; 1 of 3 anaplastic patients is NED at 44 months follow-up; 1 died of intercurrent disease at 80 months; the th ird died of disease at 49 months. All three glioblastomas succumbed to local disease at 9, 15, and 27 months from diagnosis. Univariate anal ysis showed only grade to be prognostically significant (p < .03) in d etermining overall survival. Conclusion: Postoperative radiotherapy fo r unresected or partially resected low-grade astrocytomas produces exc ellent local control. Higher grade astrocytomas require further invest igational studies to improve survival and local control. Grade is prog nostically significant with respect to overall survival.