Intramedullary astrocytomas (IMAs) are the second most frequent intramedullary tumors in adults. Low-grade IMAs (LG-IMA, WHO grade I and II) carry a better prognosis than high-grade IMAs (HG-IMAs). However, adjuvant treatment of LG-IMAs by radiotherapy (RT) and/or chemotherapy (CT) as well as treatment of tumor recurrences remains controversial. The aim of our study was to evaluate the postoperative outcome of LG-IMAs and the management of recurring tumors. We retrospectively reviewed a series of patients operated on for IMA from 1980 to 2022 in a single neurosurgical department. We retrieved 40 patients who received surgery for intramedullary astrocytomas, including 30 LG-IMAs (22 WHO grade I; 5 WHO grade II; 3 “low-grade”) and 10 HG-IMAs (4 WHO grade III; 5 WHO grade IV; 1 “high-grade”). Of the patients with LG-IMAs, the extent of surgical resection was large (gross or subtotal resection >90%) in 30% of cases. Immediate postoperative radiotherapy and/or chemotherapy was proposed only to patients who underwent biopsy (n = 5), while others were initially followed-up. Over a median follow-up of 59 months (range = 13–376), 16 LG-IMA (53.3%) recurred with a mean delay of 28.5 months after surgery (range = 3–288). These included seven biopsies, five partial resections (PR), four subtotal resections (STR) but no gross total resections (GTR). Progression-free survival for LG-IMAs was 51.9% at 3 years and 35.6% at 5 and 10 years; overall survival was 96.3% at 3 years; 90.9% at 5 years and 81.9% at 10 years. There were no significant differences in terms of OS and PFS between WHO grade I and grade II tumors. However, “large resections” (GTR or STR), as opposed to “limited resections” (PR and biopsies), were associated with both better OS (p= 0.14) and PFS (p= 0.04). The treatment of recurrences consisted of surgery alone (n = 3), surgery with RT and/or CT (n = 2), RT with CT (n = 3), RT alone (n = 2) or CT alone (n = 2). In conclusion, although LG-IMAs are infiltrating tumors, the extent of resection (GTR or STR), but not WHO grading, is the main prognostic factor. The management of recurring tumors is highly variable with no conclusive evidence for either option.
髓内星形细胞瘤是成人第二常见的髓内肿瘤。低级别髓内星形细胞瘤（WHO I级和II级）较高级别肿瘤预后更佳。然而，针对低级别髓内星形细胞瘤的放疗和/或化疗辅助治疗以及肿瘤复发的处理策略仍存争议。本研究旨在评估低级别髓内星形细胞瘤术后疗效及复发肿瘤的治疗方案。我们回顾性分析了1980年至2022年间单一神经外科中心接受手术的髓内星形细胞瘤患者队列，共纳入40例手术患者，其中低级别肿瘤30例（WHO I级22例，II级5例，“低级别”3例），高级别肿瘤10例（WHO III级4例，IV级5例，“高级别”1例）。在低级别肿瘤患者中，30%实现了大范围切除（大体或次全切除>90%）。术后即刻放疗和/或化疗仅适用于活检患者（5例），其余患者初始采取随访观察。中位随访59个月（范围13-376个月）期间，16例低级别肿瘤（53.3%）复发，平均复发时间为术后28.5个月（范围3-288个月）。复发病例包括7例活检、5例部分切除、4例次全切除，但无大体全切除病例。低级别肿瘤患者的无进展生存率在3年、5年和10年分别为51.9%、35.6%和35.6%；总生存率在3年、5年和10年分别为96.3%、90.9%和81.9%。WHO I级与II级肿瘤的总生存率和无进展生存率无显著差异。然而，与“有限切除”（部分切除和活检）相比，“大范围切除”（大体全切除或次全切除）与更优的总生存率（p=0.14）和无进展生存率（p=0.04）相关。复发治疗包括单纯手术（3例）、手术联合放化疗（2例）、放化疗联合（3例）、单纯放疗（2例）或单纯化疗（2例）。结论：尽管低级别髓内星形细胞瘤具有浸润性，但切除范围（大体全切除或次全切除）而非WHO分级是主要预后因素。复发肿瘤的治疗方案差异显著，目前尚无确凿证据支持特定治疗选择。
Management and Outcome of Recurring Low-Grade Intramedullary Astrocytomas
肿瘤(癌症)患者之家