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Supratentorial low grade astrocytoma:
prognostic factors, dedifferentiation, and the issue of early versus
late surgery
M L C van Veelen,
C J J Avezaat, J M Kros, W
van Putten, Ch Vecht
Departments of Neurosurgery and
Neuropathology, University Hospital Rotterdam and Departments of
Neurology and Medical Statistics, Dr Daniel den Hoed Cancer Center,
Rotterdam, The Netherlands. Correspondence to: Dr MLC van Veelen,
Department of Neurosurgery, Academic Hospital Rotterdam, Dr
Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Telephone 0031 10 463 9222; Fax 0031 10 463 3735.
Received 12 September 1996 and in revised form 15 August 1997;
Accepted 20 November 1997.
Background. A
retrospective study of patients with low grade astrocytoma was carried
out because the best management of such patients remains
controversial.
Prognostic factors were identified
by multivariate analysis.
Special attention was paid to the
effect of extent and timing of surgery. Methods.
Ninety patients with low grade astrocytoma were studied.
Seventy two patients had resective surgery, 15 had a diagnostic
biopsy only, and three patients had resective surgery after
initial biopsy. Results.
Significant prognostic factors for survival were age, preoperative
neurological condition, epilepsy as the single sign, extent of
surgery, and histology.
The extent of surgery was highly significant on univariate
analysis (p=0.002); however, after correction for age and
preoperative symptoms this was considerably reduced (p=0.04).
A subgroup of 30 patients with epilepsy as their single
presenting symptom was identified.
Thirteen of these patients were treated immediately after
diagnosis, whereas the other 17 patients were initially
followed up and treated only after clinical or radiological progression.
Survival in both groups was identical (63% survival rate
after five years) and much better than survival for the whole group
(27% survival rate after five years).
Malignant dedifferentiation was observed in 25 (70%)
of 36 patients who were reoperated, after a median
period of 37 months.
This period was 41 months for the subgroup of patients
with epilepsy only and 28 months for the remaining
patients. Conclusions.
Due to the retrospective nature of the study only restricted
conclusions can be drawn.
Low grade glioma with epilepsy as the single symptom has a
much better prognosis than if accompanied by other
symptoms.
This prognosis is not influenced by the timing of
surgery.
It seems, therefore, safe to defer surgery until clinical or
radiological progression in low grade glioma with epilepsy only.
Keywords: low grade astrocytoma; prognostic factors;
dedifferentiation; deferred surgery
© 1998 by Journal of Neurology,
Neurosurgery, and Psychiatry
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