Astrocytoma natural history: Difference between revisions

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__NOTOC__
__NOTOC__
{{Astrocytoma}}
{{Astrocytoma}}
{{CMG}}; {{AE}} {{Fs}}, {{Ammu}}
==Overview==
==Overview==
==Natural History==
==Complications==
==Prognosis==
===Low-grade astrocytomas===
* Low-grade astrocytomas (grade I [pilocytic] and grade II) have a relatively favorable prognosis, particularly for circumscribed, grade I lesions where complete excision may be possible.<ref name="pmid7969301">{{cite journal| author=Pollack IF| title=Brain tumors in children. | journal=N Engl J Med | year= 1994 | volume= 331 | issue= 22 | pages= 1500-7 | pmid=7969301 | doi=10.1056/NEJM199412013312207 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7969301  }} </ref><ref name="pmid19322538">{{cite journal| author=Pfister S, Witt O| title=Pediatric gliomas. | journal=Recent Results Cancer Res | year= 2009 | volume= 171 | issue=  | pages= 67-81 | pmid=19322538 | doi=10.1007/978-3-540-31206-2_4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19322538  }} </ref><ref name="pmid18386785">{{cite journal| author=Fisher PG, Tihan T, Goldthwaite PT, Wharam MD, Carson BS, Weingart JD et al.| title=Outcome analysis of childhood low-grade astrocytomas. | journal=Pediatr Blood Cancer | year= 2008 | volume= 51 | issue= 2 | pages= 245-50 | pmid=18386785 | doi=10.1002/pbc.21563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18386785  }} </ref><ref name="pmid24482038">{{cite journal| author=Bandopadhayay P, Bergthold G, London WB, Goumnerova LC, Morales La Madrid A, Marcus KJ et al.| title=Long-term outcome of 4,040 children diagnosed with pediatric low-grade gliomas: an analysis of the Surveillance Epidemiology and End Results (SEER) database. | journal=Pediatr Blood Cancer | year= 2014 | volume= 61 | issue= 7 | pages= 1173-9 | pmid=24482038 | doi=10.1002/pbc.24958 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24482038  }} </ref> Tumor spread, when it occurs, is usually by contiguous extension; dissemination to other CNS sites is uncommon, but does occur.<ref name="pmid21319282">{{cite journal| author=von Hornstein S, Kortmann RD, Pietsch T, Emser A, Warmuth-Metz M, Soerensen N et al.| title=Impact of chemotherapy on disseminated low-grade glioma in children and adolescents: report from the HIT-LGG 1996 trial. | journal=Pediatr Blood Cancer | year= 2011 | volume= 56 | issue= 7 | pages= 1046-54 | pmid=21319282 | doi=10.1002/pbc.23006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21319282  }} </ref><ref name="pmid22401918">{{cite journal| author=Mazloom A, Hodges JC, Teh BS, Chintagumpala M, Paulino AC| title=Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination. | journal=Int J Radiat Oncol Biol Phys | year= 2012 | volume= 84 | issue= 2 | pages= 350-4 | pmid=22401918 | doi=10.1016/j.ijrobp.2011.12.044 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22401918  }} </ref> Although metastasis is uncommon, tumors may be of multifocal origin, especially when associated with NF1.
* Unfavorable prognostic features for childhood low-grade astrocytomas include the following:<ref name="pmid20861086">{{cite journal| author=Stokland T, Liu JF, Ironside JW, Ellison DW, Taylor R, Robinson KJ et al.| title=A multivariate analysis of factors determining tumor progression in childhood low-grade glioma: a population-based cohort study (CCLG CNS9702). | journal=Neuro Oncol | year= 2010 | volume= 12 | issue= 12 | pages= 1257-68 | pmid=20861086 | doi=10.1093/neuonc/noq092 | pmc=PMC3018938 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20861086  }} </ref><ref name="pmid24039013">{{cite journal| author=Mirow C, Pietsch T, Berkefeld S, Kwiecien R, Warmuth-Metz M, Falkenstein F et al.| title=Children <1 year show an inferior outcome when treated according to the traditional LGG treatment strategy: a report from the German multicenter trial HIT-LGG 1996 for children with low grade glioma (LGG). | journal=Pediatr Blood Cancer | year= 2014 | volume= 61 | issue= 3 | pages= 457-63 | pmid=24039013 | doi=10.1002/pbc.24729 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24039013  }} </ref>
:* Young age.
:* Fibrillary histology.
:* Inability to obtain a complete resection.
* In patients with pilocytic astrocytoma, elevated MIB-1 labeling index, a marker of cellular proliferative activity, is associated with shortened PFS.<ref name="pmid21653594">{{cite journal| author=Margraf LR, Gargan L, Butt Y, Raghunathan N, Bowers DC| title=Proliferative and metabolic markers in incompletely excised pediatric pilocytic astrocytomas--an assessment of 3 new variables in predicting clinical outcome. | journal=Neuro Oncol | year= 2011 | volume= 13 | issue= 7 | pages= 767-74 | pmid=21653594 | doi=10.1093/neuonc/nor041 | pmc=PMC3129272 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21653594  }} </ref><ref name="pmid21610142">{{cite journal| author=Hawkins C, Walker E, Mohamed N, Zhang C, Jacob K, Shirinian M et al.| title=BRAF-KIAA1549 fusion predicts better clinical outcome in pediatric low-grade astrocytoma. | journal=Clin Cancer Res | year= 2011 | volume= 17 | issue= 14 | pages= 4790-8 | pmid=21610142 | doi=10.1158/1078-0432.CCR-11-0034 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21610142  }} </ref> A BRAF-KIAA fusion, found in pilocytic tumors, confers a better clinical outcome.
* Children with isolated optic nerve tumors have a better prognosis than those with lesions that involve the chiasm or that extend along the optic pathway.<ref name="pmid8832464">{{cite journal| author=Campbell JW, Pollack IF| title=Cerebellar astrocytomas in children. | journal=J Neurooncol | year= 1996 | volume= 28 | issue= 2-3 | pages= 223-31 | pmid=8832464 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8832464  }} </ref><ref name="pmid1738456">{{cite journal| author=Schneider JH, Raffel C, McComb JG| title=Benign cerebellar astrocytomas of childhood. | journal=Neurosurgery | year= 1992 | volume= 30 | issue= 1 | pages= 58-62; discussion 62-3 | pmid=1738456 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1738456  }} </ref><ref name="pmid12145515">{{cite journal| author=Due-Tønnessen BJ, Helseth E, Scheie D, Skullerud K, Aamodt G, Lundar T| title=Long-term outcome after resection of benign cerebellar astrocytomas in children and young adults (0-19 years): report of 110 consecutive cases. | journal=Pediatr Neurosurg | year= 2002 | volume= 37 | issue= 2 | pages= 71-80 | pmid=12145515 | doi=65108 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12145515  }} </ref>; Children with NF1 also have a better prognosis, especially when the tumor is found in asymptomatic patients at the time of screening.
* Grade 2 astrocytomas are defined as being invasive gliomas, meaning that the tumor cells penetrate into the surrounding normal brain. People with oligodendrogliomas (which might share common cells of origin[3]) have better prognoses than those with mixed oligoastrocytomas, who in turn have better prognoses than patients with (pure) low-grade astrocytomas. Individuals with grade 2 astrocytoma have a 5-year survival rate of about 34% without treatment and about 70% with radiation therapy.[2] The median survival time is 4 years.[2]


===High-Grade Astrocytomas===
If left untreated, all of patients with [[Low grade astrocytoma|low grade astrocytomas]] will have a rapid growth of the tumor similar to [[high grade astrocytoma]] and all of the patients with [[high grade astrocytoma]] will become [[symptomatic]] and deteriorate. Astrocytoma being a space occupying [[lesion]] may have following complications depending on the location of the [[tumor]] including [[increased intracranial pressure]], [[cognitive]] dysfunction, [[Emotional disorders|emotional disturbances]], behavioral complications, [[Visual disturbance|visual defects]] and [[muscle weakness]]. [[Low grade astrocytoma|Low-grade astrocytomas]] (grade I [<nowiki/>[[Pilocytic astrocytoma|pilocytic]]] and grade II) have a relatively favorable [[prognosis]], particularly for circumscribed, grade I lesions where complete excision may be possible. [[High grade astrocytoma|High-grade astrocytomas]] generally carry a poor [[prognosis]] in younger patients.
* Biologic markers, such as p53 overexpression and mutation status, may be useful predictors of outcome in patients with high-grade gliomas. MIB-1 labeling index is predictive of outcome in childhood malignant brain tumors.<ref name="pmidPMID: 16195804">{{cite journal| author=Rood BR, MacDonald TJ| title=Pediatric high-grade glioma: molecular genetic clues for innovative therapeutic approaches. | journal=J Neurooncol | year= 2005 | volume= 75 | issue= 3 | pages= 267-72 | pmid=PMID: 16195804 | doi=10.1007/s11060-005-6749-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16195804  }} </ref> Both histologic classification and proliferative activity evaluation have been shown to be independently associated with survival.<ref name="pmid12015841">{{cite journal| author=Pollack IF, Hamilton RL, Burnham J, Holmes EJ, Finkelstein SD, Sposto R et al.| title=Impact of proliferation index on outcome in childhood malignant gliomas: results in a multi-institutional cohort. | journal=Neurosurgery | year= 2002 | volume= 50 | issue= 6 | pages= 1238-44; discussion 1244-5 | pmid=12015841 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12015841  }} </ref>
 
* Although high-grade astrocytomas generally carry a poor prognosis in younger patients, those with anaplastic astrocytomas in whom a gross-total resection is possible may fare better.
 
* For low grade astrocytomas, removal of the tumor will generally allow functional survival for many years.
 
* In some reports, the five-year survival has been over 90% with well resected tumors.
== Natural History, Complications, and Prognosis ==
* To date, complete resection of high grade astrocytomas is impossible because of the diffuse infiltration of tumor cells into normal parenchyma.  Thus, high grade astrocytomas inevitably recur after initial surgery or therapy, and are usually treated similarly as the initial tumor.  
 
* Individuals with grade 3 astrocytoma have a median survival time of 18 months without treatment (radiation and chemotherapy).  
===Natural History===
* Although radiotherapy rarely cures glioblastoma multiforme, studies show that it doubles the median survival of patients, compared to supportive care alone."[3] The prognosis is worst for these grade 4 gliomas. Few patients survive beyond 3 years. Individuals with grade 4 astrocytoma have a median survival time of 17[2] weeks without treatment, 30[2] weeks with radiation, and 37[2] weeks with surgical removal of most of the tumor followed by radiation therapy. Long-term survival (at least five years) falls well under 3%
* [[Low grade astrocytoma]]:<ref name="pmid1586143">{{cite journal |vauthors=Recht LD, Lew R, Smith TW |title=Suspected low-grade glioma: is deferring treatment safe? |journal=Ann. Neurol. |volume=31 |issue=4 |pages=431–6 |date=April 1992 |pmid=1586143 |doi=10.1002/ana.410310413 |url=}}</ref><ref name="pmid10751254">{{cite journal |vauthors=Olson JD, Riedel E, DeAngelis LM |title=Long-term outcome of low-grade oligodendroglioma and mixed glioma |journal=Neurology |volume=54 |issue=7 |pages=1442–8 |date=April 2000 |pmid=10751254 |doi= |url=}}</ref><ref name="pmid19395201">{{cite journal |vauthors=Bauman G, Fisher B, Watling C, Cairncross JG, Macdonald D |title=Adult supratentorial low-grade glioma: long-term experience at a single institution |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=75 |issue=5 |pages=1401–7 |date=December 2009 |pmid=19395201 |doi=10.1016/j.ijrobp.2009.01.010 |url=}}</ref><ref name="pmid16470608">{{cite journal |vauthors=Claus EB, Black PM |title=Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas: data from the SEER program, 1973-2001 |journal=Cancer |volume=106 |issue=6 |pages=1358–63 |date=March 2006 |pmid=16470608 |doi=10.1002/cncr.21733 |url=}}</ref>
** The natural history of all [[Low grade astrocytoma|low grade astrocytomas]] is not the same.
** Most of the patients experience almost no progression of symptoms for initial 5 to 7 years.
** If left untreated, all the patients with [[Low grade astrocytoma|low grade astrocytomas]] will have rapid growth of tumor similar to [[high grade astrocytoma]].
* [[High grade astrocytoma]]:
** If left untreated, all of the patients become symptomatic and deteriorate.
** Recurrence is more common in [[high grade astrocytoma]] compared to [[low grade astrocytoma]].<ref name="pmid8727811">{{cite journal| author=Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Knisel JP et al.| title=Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. | journal=Neurosurgery | year= 1996 | volume= 38 | issue= 5 | pages= 872-8; discussion 878-9 | pmid=8727811 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8727811  }} </ref>
===Complications===
* Astrocytoma being a space occupying [[lesion]] may have following complications depending on the location of the [[tumor]]:<ref name="pmid20026498">{{cite journal |vauthors=Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S |title=Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS |journal=Pediatrics |volume=125 |issue=1 |pages=112–9 |date=January 2010 |pmid=20026498 |doi=10.1542/peds.2009-0254 |url=}}</ref><ref name="pmid16547083">{{cite journal |vauthors=Wilne SH, Ferris RC, Nathwani A, Kennedy CR |title=The presenting features of brain tumours: a review of 200 cases |journal=Arch. Dis. Child. |volume=91 |issue=6 |pages=502–6 |date=June 2006 |pmid=16547083 |pmc=2082784 |doi=10.1136/adc.2005.090266 |url=}}</ref><ref name="pmid17644483">{{cite journal |vauthors=Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D |title=Presentation of childhood CNS tumours: a systematic review and meta-analysis |journal=Lancet Oncol. |volume=8 |issue=8 |pages=685–95 |date=August 2007 |pmid=17644483 |doi=10.1016/S1470-2045(07)70207-3 |url=}}</ref>
:* [[Increased intracranial pressure]]
:* Cognitive dysfunction
:* Emotional disturbances
:* Behavioral complications
:* Visual defects
:* [[Muscle weakness]]
:* Local neurological deficit
===Prognosis===
 
==== Low-grade astrocytomas ====
* [[Low grade astrocytoma|Low-grade astrocytomas]] (grade I [<nowiki/>[[Pilocytic astrocytoma|pilocytic]]] and grade II) have a relatively favorable [[prognosis]], particularly for circumscribed, grade I lesions where complete excision is possible.<ref name="pmid7969301">{{cite journal| author=Pollack IF| title=Brain tumors in children. | journal=N Engl J Med | year= 1994 | volume= 331 | issue= 22 | pages= 1500-7 | pmid=7969301 | doi=10.1056/NEJM199412013312207 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7969301  }} </ref><ref name="pmid19322538">{{cite journal| author=Pfister S, Witt O| title=Pediatric gliomas. | journal=Recent Results Cancer Res | year= 2009 | volume= 171 | issue=  | pages= 67-81 | pmid=19322538 | doi=10.1007/978-3-540-31206-2_4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19322538  }} </ref><ref name="pmid18386785">{{cite journal| author=Fisher PG, Tihan T, Goldthwaite PT, Wharam MD, Carson BS, Weingart JD et al.| title=Outcome analysis of childhood low-grade astrocytomas. | journal=Pediatr Blood Cancer | year= 2008 | volume= 51 | issue= 2 | pages= 245-50 | pmid=18386785 | doi=10.1002/pbc.21563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18386785  }} </ref><ref name="pmid24482038">{{cite journal| author=Bandopadhayay P, Bergthold G, London WB, Goumnerova LC, Morales La Madrid A, Marcus KJ et al.| title=Long-term outcome of 4,040 children diagnosed with pediatric low-grade gliomas: an analysis of the Surveillance Epidemiology and End Results (SEER) database. | journal=Pediatr Blood Cancer | year= 2014 | volume= 61 | issue= 7 | pages= 1173-9 | pmid=24482038 | doi=10.1002/pbc.24958 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24482038  }} </ref>
* [[Tumor]] spread, when it occurs, is usually by contiguous extension; dissemination to other [[CNS]] sites may occur, although uncommon.<ref name="pmid21319282">{{cite journal| author=von Hornstein S, Kortmann RD, Pietsch T, Emser A, Warmuth-Metz M, Soerensen N et al.| title=Impact of chemotherapy on disseminated low-grade glioma in children and adolescents: report from the HIT-LGG 1996 trial. | journal=Pediatr Blood Cancer | year= 2011 | volume= 56 | issue= 7 | pages= 1046-54 | pmid=21319282 | doi=10.1002/pbc.23006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21319282  }} </ref><ref name="pmid22401918">{{cite journal| author=Mazloom A, Hodges JC, Teh BS, Chintagumpala M, Paulino AC| title=Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination. | journal=Int J Radiat Oncol Biol Phys | year= 2012 | volume= 84 | issue= 2 | pages= 350-4 | pmid=22401918 | doi=10.1016/j.ijrobp.2011.12.044 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22401918  }} </ref>
* Although, [[metastasis]] is uncommon, [[tumor]]s may be of multi-focal origin, especially when associated with [[neurofibromatosis 1]] (NF1).
* Unfavorable prognostic features for childhood [[Low grade astrocytoma|low-grade astrocytomas]] include:<ref name="pmid20861086">{{cite journal| author=Stokland T, Liu JF, Ironside JW, Ellison DW, Taylor R, Robinson KJ et al.| title=A multivariate analysis of factors determining tumor progression in childhood low-grade glioma: a population-based cohort study (CCLG CNS9702). | journal=Neuro Oncol | year= 2010 | volume= 12 | issue= 12 | pages= 1257-68 | pmid=20861086 | doi=10.1093/neuonc/noq092 | pmc=PMC3018938 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20861086  }} </ref><ref name="pmid24039013">{{cite journal| author=Mirow C, Pietsch T, Berkefeld S, Kwiecien R, Warmuth-Metz M, Falkenstein F et al.| title=Children <1 year show an inferior outcome when treated according to the traditional LGG treatment strategy: a report from the German multicenter trial HIT-LGG 1996 for children with low grade glioma (LGG). | journal=Pediatr Blood Cancer | year= 2014 | volume= 61 | issue= 3 | pages= 457-63 | pmid=24039013 | doi=10.1002/pbc.24729 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24039013  }} </ref>
:* Young age
:* Fibrillary histology
:* Inability to obtain a complete [[resection]]
* In patients with [[pilocytic astrocytoma]], elevated MIB-1 labeling index, a marker of cellular activity, is associated with reduced progression-free survival.<ref name="pmid21653594">{{cite journal| author=Margraf LR, Gargan L, Butt Y, Raghunathan N, Bowers DC| title=Proliferative and metabolic markers in incompletely excised pediatric pilocytic astrocytomas--an assessment of 3 new variables in predicting clinical outcome. | journal=Neuro Oncol | year= 2011 | volume= 13 | issue= 7 | pages= 767-74 | pmid=21653594 | doi=10.1093/neuonc/nor041 | pmc=PMC3129272 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21653594  }} </ref><ref name="pmid21610142">{{cite journal| author=Hawkins C, Walker E, Mohamed N, Zhang C, Jacob K, Shirinian M et al.| title=BRAF-KIAA1549 fusion predicts better clinical outcome in pediatric low-grade astrocytoma. | journal=Clin Cancer Res | year= 2011 | volume= 17 | issue= 14 | pages= 4790-8 | pmid=21610142 | doi=10.1158/1078-0432.CCR-11-0034 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21610142  }} </ref>
* A [[BRAF]]-KIAA fusion, found in [[Pilocytic astrocytoma|pilocytic tumors]], confers a better clinical outcome.
* Children with isolated [[optic nerve]] [[tumor]]s have a better [[prognosis]] than those with [[lesion]]s that involve the [[Chiasma|chiasm]] or that extend along the optic pathway.<ref name="pmid8832464">{{cite journal| author=Campbell JW, Pollack IF| title=Cerebellar astrocytomas in children. | journal=J Neurooncol | year= 1996 | volume= 28 | issue= 2-3 | pages= 223-31 | pmid=8832464 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8832464  }} </ref><ref name="pmid1738456">{{cite journal| author=Schneider JH, Raffel C, McComb JG| title=Benign cerebellar astrocytomas of childhood. | journal=Neurosurgery | year= 1992 | volume= 30 | issue= 1 | pages= 58-62; discussion 62-3 | pmid=1738456 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1738456  }} </ref>
* Children with [[NF1]] also have a better [[prognosis]], especially when the [[tumor]] is found in asymptomatic patients at the time of [[screening]].
* Grade 2 astrocytomas are defined as being [[invasive]] [[gliomas]], meaning that the [[tumor]] [[cell]]s penetrate into the surrounding normal [[brain]].
* People with [[oligodendrogliomas]] (which might share common [[cell]]s of origin) have better [[prognosis]] than those with mixed [[Oligoastrocytoma|oligoastrocytomas]], who in turn have better [[prognosis]] than patients with (pure) [[Low grade astrocytoma|low-grade astrocytomas]].
* Individuals with grade 2 astrocytoma have a 5-year survival rate of about 34% without treatment and about 70% with [[radiation therapy]]. The median survival time is 4 years.<ref name="pmid12145515">{{cite journal| author=Due-Tønnessen BJ, Helseth E, Scheie D, Skullerud K, Aamodt G, Lundar T| title=Long-term outcome after resection of benign cerebellar astrocytomas in children and young adults (0-19 years): report of 110 consecutive cases. | journal=Pediatr Neurosurg | year= 2002 | volume= 37 | issue= 2 | pages= 71-80 | pmid=12145515 | doi=65108 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12145515  }} </ref>
 
==== High-grade astrocytomas ====
* Biologic markers, such as [[p53]] [[overexpression]] and [[mutation]] status, may be useful predictors of outcome in patients with high-grade [[gliomas]].
** MIB-1 labeling index is predictive of outcome in childhood [[malignant]] brain [[tumors]].<ref name="pmidPMID: 16195804">{{cite journal| author=Rood BR, MacDonald TJ| title=Pediatric high-grade glioma: molecular genetic clues for innovative therapeutic approaches. | journal=J Neurooncol | year= 2005 | volume= 75 | issue= 3 | pages= 267-72 | pmid=PMID: 16195804 | doi=10.1007/s11060-005-6749-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16195804  }} </ref>
** Both histologic classification and proliferative activity evaluation have been shown to be independently associated with survival.<ref name="pmid12015841">{{cite journal| author=Pollack IF, Hamilton RL, Burnham J, Holmes EJ, Finkelstein SD, Sposto R et al.| title=Impact of proliferation index on outcome in childhood malignant gliomas: results in a multi-institutional cohort. | journal=Neurosurgery | year= 2002 | volume= 50 | issue= 6 | pages= 1238-44; discussion 1244-5 | pmid=12015841 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12015841  }} </ref>
* Although, [[High grade astrocytoma|high-grade astrocytomas]] generally carry a poor [[prognosis]] in younger patients, those with [[Anaplastic astrocytoma|anaplastic astrocytomas]] in whom a gross-total [[resection]] is possible may fare better.
* For [[Low grade astrocytoma|low grade astrocytomas]], removal of the [[tumor]] will generally allow functional survival for many years.
* In some reports, the five-year survival has been over 90% with well resected [[tumor]]s.
* To date, complete resection of [[High grade astrocytoma|high grade astrocytomas]] is impossible because of the diffuse infiltration of [[tumor]] [[cell]]s.
* [[Radiation therapy]] has been shown to prolong survival and is a standard component of treatment of [[anaplastic astrocytoma]].
* Individuals with grade 3 astrocytoma have a [[median]] survival time of 18 months without treatment ([[radiation]] and [[chemotherapy]]).
* Although [[radiotherapy]] rarely cures [[glioblastoma multiforme]], studies show that it doubles the median survival of patients, compared to supportive care alone.
* The [[prognosis]] is worst for these grade 4 [[glioma]]s.<ref name="pmid15497115">{{cite journal |vauthors=See SJ, Gilbert MR |title=Anaplastic astrocytoma: diagnosis, prognosis, and management |journal=Semin. Oncol. |volume=31 |issue=5 |pages=618–34 |date=October 2004 |pmid=15497115 |doi= |url=}}</ref><ref name="pmid12187956">{{cite journal |vauthors=Korshunov A, Golanov A, Sycheva R |title=Immunohistochemical markers for prognosis of anaplastic astrocytomas |journal=J. Neurooncol. |volume=58 |issue=3 |pages=203–15 |date=July 2002 |pmid=12187956 |doi= |url=}}</ref><ref name="pmid2990664">{{cite journal |vauthors=Burger PC, Vogel FS, Green SB, Strike TA |title=Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications |journal=Cancer |volume=56 |issue=5 |pages=1106–11 |date=September 1985 |pmid=2990664 |doi= |url=}}</ref>
** Few patients survive beyond 3 years.
** Individuals with grade 4 astrocytoma have a median survival time of:
*** 17 weeks without treatment,
*** 30 weeks with [[radiation]]
*** 37 weeks with surgical removal of most of the [[tumors]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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[[Category:Pathology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 15:14, 25 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Ammu Susheela, M.D. [2]

Overview

If left untreated, all of patients with low grade astrocytomas will have a rapid growth of the tumor similar to high grade astrocytoma and all of the patients with high grade astrocytoma will become symptomatic and deteriorate. Astrocytoma being a space occupying lesion may have following complications depending on the location of the tumor including increased intracranial pressure, cognitive dysfunction, emotional disturbances, behavioral complications, visual defects and muscle weakness. Low-grade astrocytomas (grade I [pilocytic] and grade II) have a relatively favorable prognosis, particularly for circumscribed, grade I lesions where complete excision may be possible. High-grade astrocytomas generally carry a poor prognosis in younger patients.


Natural History, Complications, and Prognosis

Natural History

Complications

  • Astrocytoma being a space occupying lesion may have following complications depending on the location of the tumor:[6][7][8]

Prognosis

Low-grade astrocytomas

  • Young age
  • Fibrillary histology
  • Inability to obtain a complete resection

High-grade astrocytomas

References

  1. ↑ Recht LD, Lew R, Smith TW (April 1992). "Suspected low-grade glioma: is deferring treatment safe?". Ann. Neurol. 31 (4): 431–6. doi:10.1002/ana.410310413. PMID 1586143.
  2. ↑ Olson JD, Riedel E, DeAngelis LM (April 2000). "Long-term outcome of low-grade oligodendroglioma and mixed glioma". Neurology. 54 (7): 1442–8. PMID 10751254.
  3. ↑ Bauman G, Fisher B, Watling C, Cairncross JG, Macdonald D (December 2009). "Adult supratentorial low-grade glioma: long-term experience at a single institution". Int. J. Radiat. Oncol. Biol. Phys. 75 (5): 1401–7. doi:10.1016/j.ijrobp.2009.01.010. PMID 19395201.
  4. ↑ Claus EB, Black PM (March 2006). "Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas: data from the SEER program, 1973-2001". Cancer. 106 (6): 1358–63. doi:10.1002/cncr.21733. PMID 16470608.
  5. ↑ Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Knisel JP; et al. (1996). "Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas". Neurosurgery. 38 (5): 872–8, discussion 878-9. PMID 8727811.
  6. ↑ Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S (January 2010). "Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS". Pediatrics. 125 (1): 112–9. doi:10.1542/peds.2009-0254. PMID 20026498.
  7. ↑ Wilne SH, Ferris RC, Nathwani A, Kennedy CR (June 2006). "The presenting features of brain tumours: a review of 200 cases". Arch. Dis. Child. 91 (6): 502–6. doi:10.1136/adc.2005.090266. PMC 2082784. PMID 16547083.
  8. ↑ Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D (August 2007). "Presentation of childhood CNS tumours: a systematic review and meta-analysis". Lancet Oncol. 8 (8): 685–95. doi:10.1016/S1470-2045(07)70207-3. PMID 17644483.
  9. ↑ Pollack IF (1994). "Brain tumors in children". N Engl J Med. 331 (22): 1500–7. doi:10.1056/NEJM199412013312207. PMID 7969301.
  10. ↑ Pfister S, Witt O (2009). "Pediatric gliomas". Recent Results Cancer Res. 171: 67–81. doi:10.1007/978-3-540-31206-2_4. PMID 19322538.
  11. ↑ Fisher PG, Tihan T, Goldthwaite PT, Wharam MD, Carson BS, Weingart JD; et al. (2008). "Outcome analysis of childhood low-grade astrocytomas". Pediatr Blood Cancer. 51 (2): 245–50. doi:10.1002/pbc.21563. PMID 18386785.
  12. ↑ Bandopadhayay P, Bergthold G, London WB, Goumnerova LC, Morales La Madrid A, Marcus KJ; et al. (2014). "Long-term outcome of 4,040 children diagnosed with pediatric low-grade gliomas: an analysis of the Surveillance Epidemiology and End Results (SEER) database". Pediatr Blood Cancer. 61 (7): 1173–9. doi:10.1002/pbc.24958. PMID 24482038.
  13. ↑ von Hornstein S, Kortmann RD, Pietsch T, Emser A, Warmuth-Metz M, Soerensen N; et al. (2011). "Impact of chemotherapy on disseminated low-grade glioma in children and adolescents: report from the HIT-LGG 1996 trial". Pediatr Blood Cancer. 56 (7): 1046–54. doi:10.1002/pbc.23006. PMID 21319282.
  14. ↑ Mazloom A, Hodges JC, Teh BS, Chintagumpala M, Paulino AC (2012). "Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination". Int J Radiat Oncol Biol Phys. 84 (2): 350–4. doi:10.1016/j.ijrobp.2011.12.044. PMID 22401918.
  15. ↑ Stokland T, Liu JF, Ironside JW, Ellison DW, Taylor R, Robinson KJ; et al. (2010). "A multivariate analysis of factors determining tumor progression in childhood low-grade glioma: a population-based cohort study (CCLG CNS9702)". Neuro Oncol. 12 (12): 1257–68. doi:10.1093/neuonc/noq092. PMC 3018938. PMID 20861086.
  16. ↑ Mirow C, Pietsch T, Berkefeld S, Kwiecien R, Warmuth-Metz M, Falkenstein F; et al. (2014). "Children <1 year show an inferior outcome when treated according to the traditional LGG treatment strategy: a report from the German multicenter trial HIT-LGG 1996 for children with low grade glioma (LGG)". Pediatr Blood Cancer. 61 (3): 457–63. doi:10.1002/pbc.24729. PMID 24039013.
  17. ↑ Margraf LR, Gargan L, Butt Y, Raghunathan N, Bowers DC (2011). "Proliferative and metabolic markers in incompletely excised pediatric pilocytic astrocytomas--an assessment of 3 new variables in predicting clinical outcome". Neuro Oncol. 13 (7): 767–74. doi:10.1093/neuonc/nor041. PMC 3129272. PMID 21653594.
  18. ↑ Hawkins C, Walker E, Mohamed N, Zhang C, Jacob K, Shirinian M; et al. (2011). "BRAF-KIAA1549 fusion predicts better clinical outcome in pediatric low-grade astrocytoma". Clin Cancer Res. 17 (14): 4790–8. doi:10.1158/1078-0432.CCR-11-0034. PMID 21610142.
  19. ↑ Campbell JW, Pollack IF (1996). "Cerebellar astrocytomas in children". J Neurooncol. 28 (2–3): 223–31. PMID 8832464.
  20. ↑ Schneider JH, Raffel C, McComb JG (1992). "Benign cerebellar astrocytomas of childhood". Neurosurgery. 30 (1): 58–62, discussion 62-3. PMID 1738456.
  21. ↑ Due-Tønnessen BJ, Helseth E, Scheie D, Skullerud K, Aamodt G, Lundar T (2002). "Long-term outcome after resection of benign cerebellar astrocytomas in children and young adults (0-19 years): report of 110 consecutive cases". Pediatr Neurosurg. 37 (2): 71–80. doi:65108 Check |doi= value (help). PMID 12145515.
  22. ↑ Rood BR, MacDonald TJ (2005). "Pediatric high-grade glioma: molecular genetic clues for innovative therapeutic approaches". J Neurooncol. 75 (3): 267–72. doi:10.1007/s11060-005-6749-5. PMID 16195804 PMID: 16195804 Check |pmid= value (help).
  23. ↑ Pollack IF, Hamilton RL, Burnham J, Holmes EJ, Finkelstein SD, Sposto R; et al. (2002). "Impact of proliferation index on outcome in childhood malignant gliomas: results in a multi-institutional cohort". Neurosurgery. 50 (6): 1238–44, discussion 1244-5. PMID 12015841.
  24. ↑ See SJ, Gilbert MR (October 2004). "Anaplastic astrocytoma: diagnosis, prognosis, and management". Semin. Oncol. 31 (5): 618–34. PMID 15497115.
  25. ↑ Korshunov A, Golanov A, Sycheva R (July 2002). "Immunohistochemical markers for prognosis of anaplastic astrocytomas". J. Neurooncol. 58 (3): 203–15. PMID 12187956.
  26. ↑ Burger PC, Vogel FS, Green SB, Strike TA (September 1985). "Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications". Cancer. 56 (5): 1106–11. PMID 2990664.

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