Clinical outcome of supratentorial astrocytoma WHO grade II

Objective. There are divergent opinions about the prognostic value of the e xtent of surgery and of different histological subtypes in supratentorial a strocytomas WHO grade II. Methods. We reviewed 75 consecutive patients (36 females, 39 males) with su pratentorial astrocytomas WHO grade II (59 primary and 16 recurrent tumours ) operated on between 1991 and 1995. Results. Gross total resection could be achieved in 40 astrocytomas. subtot al resection (including biopsy) was performed in 35 cases. Histological ass essment confirmed 60 fibrillary, 6 gemistocytic, 9 oligo-astrocytic and Ilo protoplasmic astrocytomas. There were no postoperative deaths. Early outco me 6 to 12 weeks after surgery according to the Glasgow Outcome Scale was g ood in 46 patients, 24 patients had moderate? and 5 had severe neurological deficits. Survival rates 1, 2, 3, and 4 years following surgery were 100%, 96%. 96%, 96% for patients wile underwent gross total tumour resection and 86%, 77%, 77%, 64% for patients with subtotal tumour resection. The cumula tive recurrence or progression rates after 4 years were 26% after gross tot al resection and 80% after subtotal resection, and this result is statistic ally significant. Recurrences after gross total resection or progressions a fter subtotal resection occurred more often in gemistocytic astrocytomas (4 0% and 100%, respectively) than in other subtypes. Dedifferentiation to a m ore malignant tumour seems to be more prominent in the gemistocytic subtype . Conclusion. Gross total resection should be the leading therapeutic option for patients with astrocytomas WHO grade II. For the gemistocytic subtype f urther studies will have to prove whether additional radiotherapy is of any benefit.