Prognostic factors in intramedullary astrocytomas: a literature review

Abstract

Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods-biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. Better understanding of factors that influence prognosis may help in treatment planning with the goal of prolonging survival. We have thus undertaken an extensive literature review in order to define factors affecting prognosis. A total of 38 articles were studied. Only tumor grade was consistently reported as the major factor affecting prognosis. The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low-and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio-and chemotherapy would be sensible to implement.

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

“…In this study, GTR was achieved in 20.5%, with great variability of reported rates for GTRs in the literature. 4,19,20,27,37,53,[56][57][58]63 Malignant tumors of Type B could never be removed completely. For benign tumors, on the other hand, GTR could be obtained with increasing frequency similar to the improving results for Type A tumors.…”

“…The influence of the histological grade on recurrence rates and patient survival is well established 4,19,27 and self-explanatory. Malignant tumors almost always recurred 19 except for some anaplastic astrocytomas, 27 which remained clinically silent even without adjuvant therapy.…”

“…This may be explained by rather low patient numbers in most studies and even smaller numbers of patients undergoing GTR. 4 Given the fact that all but 2 angioblastomas were removed completely and in toto, the rather high rate of recurrences was surprising. In VHL, a recurrence may develop anytime and anywhere in the spinal canal.…”

Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study

“…Authors of previous studies [8,10,16,17,23] have noted that astrocytomas are much more common in children than in adults. In the current series, the frequency of astrocytomas (1.3 % of the entire series) is lower than in other series studied: 9.5 % in the USA [21], 6.0 % in Germany [18], 6.0 % in Norway [16], 4.6 % in Iran [14], 6.4 % in China [2], 5.3 % in Korea [12], 2.5 % in Thailand [11].…”

Quality of life in adult intradural primary spinal tumors: 36-Item Short Form Health Survey correlation with McCormick and Aminoff-Logue scales

“…Aggressive surgery has been associated with high complication rates, and subtotal removal has been found to have fewer complications, particularly in combination with radio-and chemotherapy. 8 The decision of how to treat the lesion is the same regardless of deciding what is best for the patient. The surgeon must rely on judgment and experience in this regard.…”