gms | German Medical Science

Objective: The purpose of our study was to evaluate long-term survival in patients with pure low grade astrocytomas (LGAs), who were treated in our institute in the period of 17 years.

Methods: In the period between 1993 till 2008 we recorded a total of 235 patients with nonpilocytic low-grade gliomas according to WHO classification. All patients underwent at least one surgical procedure in our Department. The data was categorized according to patient-related factors (age, gender, etc.), tumor-related factors (size, volume, location, histology, proliferation, etc.), and therapy-related factors (extend of surgery, adjuvant technologies, adjuvant treatments, type of XRT, follow-up imaging, time to progression, survival). In addition, patients and their general practitioners were asked to complete a questionnaire to evaluate quality of life.

Results: Out of the 235 patients initially identified with a nonpilocytic low-grade glioma, we focused in our study on 128 adult patients with histologically pure low grade astrocytomas without oligodendroglial components. The median age at diagnosis was 44.5 years. Median follow-up was 9.6 years for survivors. 37 patients underwent a gross total resection, 51 patients a subtotal resection and 40 pts open or stereotactic biopsies. Overall median OS was 6 years (0.1–22.4 years). The 5- and 10-year OS rates were 72.7% and 57.7% in all patients. Postoperative radiotherapy was applied to 38 (30%) patients, of these 4 pts. received a combined radio- and chemotherapy. The median PFS of all patients was 2.7 years. The median PFS of patients with subtotal surgery and radiotherapy was 5.6 years, whereas median PFS in the surgery group was 2.8 years. The longest PFS with 3.9 years was registered in pts. with subtotal resection and adjuvant radiotherapy. 224 resections were performed in 128 patients. (On average 2 operations per patient) Malignant progression was observed in 40 pts. (32%), of these, 9 pts. (22.5%) had surgery and radiotherapy as a first line treatment.

Conclusions: Our retrospective study of ptatients with pure low grade astrocytomas suggests that postoperative radiotherapy was associated with improved PFS, especially in pts. after subtotal resection. Additional markers are needed to identify subgroups that represent responders to individualized therapies.