PEDIATRIC ASTROCYTOMAS - THE LOUISVILLE EXPERIENCE - 1978-1988

Purpose: The purpose of this study is to retrospectively analyze all pediatric patients with the diagnosis of astrocytoma treated either definitively or postoperatively in our department from 1978 through 1988. Grade, age, T-stage, tumor location, and extent of resection are individually analyzed as prognostic indicators of overall survival. Materials and Methods: Pediatric astrocytoma patients (grades I-IV) diagnosed by CT-guided biopsy or surgical resection were assessed. Patients were treated with external beam radiotherapy to involved fields using 4- or 6-MV photons. Daily doses ranged from 1.5 to 2.0 Gy; total doses from 41.4 to 66 Gy. Treatment was given to 17 patients (9 male, 8 female), aged 18 years and younger: 11 patients had low-grade (I and II) astrocytoma with incomplete margins; 3 patients had anaplastic astrocytoma; and 3 patients had glioblastoma multiforme. Results: Overall survival at 140 months was 63%. Median follow-up of patients living NED was 69 months, with a range of 39-140 months. Nine of the eleven (82%) low-grade patients survived NED; 1 of 3 anaplastic patients is NED at 44 months follow-up; 1 died of intercurrent disease at 80 months; the third died of disease at 49 months. All three glioblastomas succumbed to local disease at 9, 15, and 27 months from diagnosis. Univariate analysis showed only grade to be prognostically significant (p < .03) in determining overall survival. Conclusion: Postoperative radiotherapy for unresected or partially resected low-grade astrocytomas produces excellent local control. Higher grade astrocytomas require further investigational studies to improve survival and local control. Grade is prognostically significant with respect to overall survival.