LOW-GRADE ASTROCYTOMA - A DECADE OF EXPERIENCE AT ST-JUDE-CHILDRENS-RESEARCH-HOSPITAL

Purpose: To evaluate the impact of primary tumor site, age at diagnosi s, extent of resection, and histology on progression-free survival (PF S) in pediatric low-grade astrocytoma. Patients and Methods: Medical, pathologic, and imaging information were reviewed reviewed for 142 chi ldren (ages 2 months to 19 years) with low-grade astrocytoma treated b etween January 1984 and July 1994. Gross total resection (GTR) was att empted for cerebellar and cerebral hemisphere tumors, with biopsy or l ess aggressive resection used predominantly for rumors in other sites. Surgery was followed by observation in 107 cases, radiation therapy i n 31, and chemotherapy in four. Results. The overall survival rate was 90% +/- 3% (SE) at 4 years. PFS was significantly better for patients with cerebellar and cerebral hemisphere tumors (n = 75) than those wi th rumors in all other sites (P =.0006). Within the former group, ther e was no significant difference in PFS for patients in whom GTR was ac hieved versus those with incomplete resections (4-year estimates, 89% and 77%, respectively). Histology (juvenile pilocytic v astrocytoma no t otherwise specified [NOS]) was not related to PFS in an analysis tha t controlled for tumor site and patient age, Patients younger than 5 y ears at diagnosis had a significantly poorer PFS than older children, regardless of histology (P <.03) or tumor site (P <.002). Treatment fo r progressive/recurrent disease was effective in a majority af patient s, but appeared more successful in patients with hemispheric than thal amic or hypothalamic tumors. Conclusion: The overall survival in this series of pediatric low-grade astrocytomas is excellent. Age at diagno sis and tumor location, but not histology, had a significant impact on PFS, Efforts to improve treatment outcome should focus on young patie nts (< 5 years) and an those with central midline tumors. The majority of patients with completely resected hemispheric tumors were monitore d without further therapy, which supports attempted GTR of cerebral an d cerebellar hemisphere low-grade astrocytoma.