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. 2001 Jan;84(1):61–64. doi: 10.1136/adc.84.1.61

Low grade astrocytomas in the West of Scotland 1987-96: treatment, outcome, and cognitive functioning

S Yule 1, T Hide 1, M Cranney 1, E Simpson 1, A Barrett 1
PMCID: PMC1718630  PMID: 11124789

Abstract

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.



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Selected References

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  1. Berger M. S., Deliganis A. V., Dobbins J., Keles G. E. The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer. 1994 Sep 15;74(6):1784–1791. doi: 10.1002/1097-0142(19940915)74:6<1784::aid-cncr2820740622>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  2. Brada M., Ford D., Ashley S., Bliss J. M., Crowley S., Mason M., Rajan B., Traish D. Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. BMJ. 1992 May 23;304(6838):1343–1346. doi: 10.1136/bmj.304.6838.1343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Butler R. W., Hill J. M., Steinherz P. G., Meyers P. A., Finlay J. L. Neuropsychologic effects of cranial irradiation, intrathecal methotrexate, and systemic methotrexate in childhood cancer. J Clin Oncol. 1994 Dec;12(12):2621–2629. doi: 10.1200/JCO.1994.12.12.2621. [DOI] [PubMed] [Google Scholar]
  4. Copeland D. R., deMoor C., Moore B. D., 3rd, Ater J. L. Neurocognitive development of children after a cerebellar tumor in infancy: A longitudinal study. J Clin Oncol. 1999 Nov;17(11):3476–3486. doi: 10.1200/JCO.1999.17.11.3476. [DOI] [PubMed] [Google Scholar]
  5. Dennis M., Hetherington C. R., Spiegler B. J. Memory and attention after childhood brain tumors. Med Pediatr Oncol. 1998;Suppl 1:25–33. doi: 10.1002/(sici)1096-911x(1998)30:1+<25::aid-mpo4>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  6. Edgeworth J., Bullock P., Bailey A., Gallagher A., Crouchman M. Why are brain tumours still being missed? Arch Dis Child. 1996 Feb;74(2):148–151. doi: 10.1136/adc.74.2.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ellenberg L., McComb J. G., Siegel S. E., Stowe S. Factors affecting intellectual outcome in pediatric brain tumor patients. Neurosurgery. 1987 Nov;21(5):638–644. doi: 10.1227/00006123-198711000-00006. [DOI] [PubMed] [Google Scholar]
  8. Gajjar A., Sanford R. A., Heideman R., Jenkins J. J., Walter A., Li Y., Langston J. W., Muhlbauer M., Boyett J. M., Kun L. E. Low-grade astrocytoma: a decade of experience at St. Jude Children's Research Hospital. J Clin Oncol. 1997 Aug;15(8):2792–2799. doi: 10.1200/JCO.1997.15.8.2792. [DOI] [PubMed] [Google Scholar]
  9. Glauser T. A., Packer R. J. Cognitive deficits in long-term survivors of childhood brain tumors. Childs Nerv Syst. 1991 Feb;7(1):2–12. doi: 10.1007/BF00263824. [DOI] [PubMed] [Google Scholar]
  10. Janny P., Cure H., Mohr M., Heldt N., Kwiatkowski F., Lemaire J. J., Plagne R., Rozan R. Low grade supratentorial astrocytomas. Management and prognostic factors. Cancer. 1994 Apr 1;73(7):1937–1945. doi: 10.1002/1097-0142(19940401)73:7<1937::aid-cncr2820730727>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  11. LeBaron S., Zeltzer P. M., Zeltzer L. K., Scott S. E., Marlin A. E. Assessment of quality of survival in children with medulloblastoma and cerebellar astrocytoma. Cancer. 1988 Sep 15;62(6):1215–1222. doi: 10.1002/1097-0142(19880915)62:6<1215::aid-cncr2820620629>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  12. Moore I. M., Kramer J. H., Wara W., Halberg F., Ablin A. R. Cognitive function in children with leukemia. Effect of radiation dose and time since irradiation. Cancer. 1991 Nov 1;68(9):1913–1917. doi: 10.1002/1097-0142(19911101)68:9<1913::aid-cncr2820680912>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  13. Morantz R. A. Radiation therapy in the treatment of cerebral astrocytoma. Neurosurgery. 1987 Jun;20(6):975–982. doi: 10.1227/00006123-198706000-00028. [DOI] [PubMed] [Google Scholar]
  14. Mulhern R. K., Hancock J., Fairclough D., Kun L. Neuropsychological status of children treated for brain tumors: a critical review and integrative analysis. Med Pediatr Oncol. 1992;20(3):181–191. doi: 10.1002/mpo.2950200302. [DOI] [PubMed] [Google Scholar]
  15. North C. A., North R. B., Epstein J. A., Piantadosi S., Wharam M. D. Low-grade cerebral astrocytomas. Survival and quality of life after radiation therapy. Cancer. 1990 Jul 1;66(1):6–14. doi: 10.1002/1097-0142(19900701)66:1<6::aid-cncr2820660103>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  16. Pollack I. F., Claassen D., al-Shboul Q., Janosky J. E., Deutsch M. Low-grade gliomas of the cerebral hemispheres in children: an analysis of 71 cases. J Neurosurg. 1995 Apr;82(4):536–547. doi: 10.3171/jns.1995.82.4.0536. [DOI] [PubMed] [Google Scholar]
  17. Roman D. D., Sperduto P. W. Neuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys. 1995 Feb 15;31(4):983–998. doi: 10.1016/0360-3016(94)00550-8. [DOI] [PubMed] [Google Scholar]
  18. Silber J. H., Radcliffe J., Peckham V., Perilongo G., Kishnani P., Fridman M., Goldwein J. W., Meadows A. T. Whole-brain irradiation and decline in intelligence: the influence of dose and age on IQ score. J Clin Oncol. 1992 Sep;10(9):1390–1396. doi: 10.1200/JCO.1992.10.9.1390. [DOI] [PubMed] [Google Scholar]
  19. Sklar C. A., Constine L. S. Chronic neuroendocrinological sequelae of radiation therapy. Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1113–1121. doi: 10.1016/0360-3016(94)00427-M. [DOI] [PubMed] [Google Scholar]
  20. Wallner K. E., Gonzales M. F., Edwards M. S., Wara W. M., Sheline G. E. Treatment results of juvenile pilocytic astrocytoma. J Neurosurg. 1988 Aug;69(2):171–176. doi: 10.3171/jns.1988.69.2.0171. [DOI] [PubMed] [Google Scholar]
  21. Woo S. Y., Donaldson S. S., Cox R. S. Astrocytoma in children: 14 years' experience at Stanford University Medical Center. J Clin Oncol. 1988 Jun;6(6):1001–1007. doi: 10.1200/JCO.1988.6.6.1001. [DOI] [PubMed] [Google Scholar]

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