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Low grade astrocytomas in the West of Scotland 1987-96: treatment,
outcome, and cognitive functioning S M Yule, T A H Hide, M Cranney,
E Simpson, A Barrett
Department of Haematology, Royal
Hospital for Sick Children, Yorkhill NHS Trust, Yorkhill, Glasgow G3
8SJ, UK [S.M.Y., M.C., E.S.], Institute of Neurological
Sciences, Southern General Hospital NHS Trust, Glasgow, UK [T.A.H.H.],
Beatson
Oncology Centre, Western Infirmary, Glasgow G11 6NT, UK [A.B.]. Correspondence to: Dr Yule.
Accepted 9 May 2000. Background.
Low
grade astrocytomas are among the most common central nervous system
tumours in children. Aims.
To
identify risk factors for the development of persistent intellectual
handicap. Methods.
The
notes of 30 children with histologically proven low grade
astrocytoma who presented during the period 1987-96 were reviewed.
Thirteen of these children who were diagnosed with intracranial
tumours between 1992 and 1996 underwent cognitive
assessment one year after the completion of treatment. Results.
Low
grade astrocytomas were found in the cerebellum (59%), thalamus (17%),
cerebral hemispheres (10%), and the cervical spinal cord
(9%).
Where possible all patients were treated with gross total
resection of the tumour.
Symptomatic children with tumours judged
to be inoperable underwent biopsy followed by radiotherapy (13%).
Three patients developed progressive disease following surgery
and underwent repeat surgery and radiotherapy.
Survival at
a median follow up of 75 months (range 30-131) is 97%.
At one
year after the completion of treatment persisting cognitive
impairment was common.
The strongest predictor of IQ scores
was the duration of symptoms of increased intracranial
pressure preoperatively. Conclusions.
Although
the overall survival rate of children with low grade astrocytoma is
excellent, significant long term disability occurs.
Early
diagnosis is essential to reduce postoperative cognitive morbidity.
Keywords: low grade astrocytoma; surgery;
radiotherapy; cognitive functioning
©
2001 by Archives of Disease in Childhood
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