Astrocytoma natural history
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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.[1][2][3][4] Tumor spread, when it occurs, is usually by contiguous extension; dissemination to other CNS sites is uncommon, but does occur.[5][6] 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:[7][8]
- 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.[9][10] 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.[11][12][13]; 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. The median survival time is 4 years.
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.[14] Both histologic classification and proliferative activity evaluation have been shown to be independently associated with survival.[15]
- 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.
- To date, complete resection of high grade astrocytomas is impossible because of the diffuse infiltration of tumor cells into nor
- 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 gliomas. 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, and 37 weeks with surgical removal of most of the tumor followed by radiation therapy. Long-term survival (at least five years) falls well under 3%.
References
- ↑ Pollack IF (1994). "Brain tumors in children". N Engl J Med. 331 (22): 1500–7. doi:10.1056/NEJM199412013312207. PMID 7969301.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Campbell JW, Pollack IF (1996). "Cerebellar astrocytomas in children". J Neurooncol. 28 (2–3): 223–31. PMID 8832464.
- ↑ Schneider JH, Raffel C, McComb JG (1992). "Benign cerebellar astrocytomas of childhood". Neurosurgery. 30 (1): 58–62, discussion 62-3. PMID 1738456.
- ↑ 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. - ↑ 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). - ↑ 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.