Data for this review were identified by searches of Pubmed and Cancerlit (1980–2002) and from references of relevant articles. The search terms were “astrocytoma grade II”, “astrocytoma grade 2”, “low-grade astrocytoma”, “treatment”, and “prognosis”. Exclusion criteria were “spinal cord” and “child” and “juvenile”. Only papers published in English or German were reviewed. Only CT/MRI studies of 40 or more adult patients were included.
ReviewSupratentorial grade II astrocytoma: biological features and clinical course
Section snippets
Presenting symptoms and imaging of grade II astrocytoma
Epileptic seizure is the most common presenting symptom of grade II astrocytoma and occurs in about 80% of the patients;8, 9, 10 this is probably due to the superficial localisation and low growth rate of the tumour in many cases.11 Focal neurological deficit (30%) and mental changes (10–30%) are less common. Symptoms caused by raised intracranial pressure, such as headache, vomiting, and papilloedema (10%), are rare.8, 9, 10
Before CT, focal neurological deficit and raised intracranial pressure
Clinical course and prognostic features
The course of grade II astrocytoma is still largely unpredictable for several reasons. First, proliferation and progression are highly variable.25 Second, studies are difficult to interpret, as they are mostly retrospective in nature and include other subgroups of low-grade gliomas. Furthermore, the use of different treatment strategies may be an important confounder in most studies.
Recent studies have used CT and MRI to predict the clinical course, and have tried to describe prognostic
Treatment strategies
Age is an important factor in the design of treatment strategies for grade II astrocytoma. In older patients, the tumours are commonly more malignant than in younger patients. Most studies use 40 years (some use 35 years) of age as a cut-off point. There is agreement that patients older than 35–40 years should have aggressive treatment—ie, maximum tumour resection followed by radiation therapy.2, 52 Aggressive treatment is also recommended for younger patients with increased intracranial
Histological grading systems
At present, astrocytomas are either classified according to the St Anne-Mayo grading system60 or according to the WHO protocol.61 In both systems tumours are graded—in the most anaplastic areas—according to their nuclear atypia, mitotic activity, endothelial proliferation, and necrosis (panel).
The St Anne-Mayo system divides astrocytomas into four grades. However, in practice, this is a three-grade system because grade 1 astrocytomas are very rarely found. The most prominent feature of St
Biological features of grade II astrocytoma
Phenotype and genotypic differences underlie the variable clinical course seen in patients with grade II astrocytoma. The development of astrocytoma is associated with genetic instability and an imbalance between proliferation and apoptosis of astrocytes. Recent studies have suggested that markers for proliferation activity75, 76 and certain cytogenetic changes77, 78 may predict the malignant transformation from grade II to grade III or IV astrocytoma.
Conclusions
Because of the unpredictable clinical course of grade II astrocytoma, treatment strategies range from gross tumour resection followed by immediate radiotherapy to a “wait and see” approach. At present the best prognostic variable is the patient's age; other indicators of poor prognosis include neurological deficit and a low performance score at time of presentation.
For young patients (under 35 or 40 years of age) with indolent grade II astrocytoma, the efficacy of surgical intervention and
Search strategy and selection criteria
References (121)
Epidemiology of primary CNS neoplasms
Neurol Clin
(1996)- et al.
Radiotherapy treatment planning and long-term follow-up with [(11)C]methionine PET in patients with low-grade astrocytoma
Int J Radiat Oncol Biol Phys
(2000) - et al.
Low grade glioma of the cerebral hemispheres in adults: a retrospective analysis of 88 cases
Int J Radiat Oncol Biol Phys
(1990) - et al.
The management of histologically unverified presumed cerebral gliomas with radiotherapy
Int J Radiat Oncol Biol Phys
(1994) - et al.
Radiation therapy with or without surgery in the management of low- grade brain astrocytomas: a retrospective study of 120 patients
Bull Cancer Radiother
(1995) - et al.
Pretreatment factors predict overall survival for patients with low-grade glioma: a recursive partitioning analysis
Int J Radiat Oncol Biol Phys
(1999) - et al.
A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844
Int J Radiat Oncol Biol Phys
(1996) - et al.
Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis
Int J Radiat Oncol Biol Phys
(2002) - et al.
Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study
Lancet
(2002) - et al.
Current and future developments in the use of temozolomide for the treatment of brain tumours
Lancet Oncol
(2001)
Chromosomal patterns in human malignant astrocytomas
Cancer Genet Cytogenet
Progression as exemplified by human astrocytic tumors
Semin Cancer Biol
Amplified cellular oncogenes in neoplasms of the human central nervous system
Mutat Res
Incidence of primary central nervous system cancers in South and East Netherlands in 1989-1994
Neuroepidemiology
Radiation therapy in the management of low-grade supratentorial astrocytomas
J Neurosurg
Hereditary tumor syndromes of the nervous system: overview and rare syndromes
Brain Pathol
A report on radiation-induced gliomas
Cancer
Cellular-telephone use and brain tumors
N Engl J Med
Descriptive epidemiology of cerebral gliomas in France
Cancer
Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients
J Clin Oncol
Supratentorial World Health Organization grade 2 astrocytomas and oligoastrocytomas: a new pattern of prognostic factors
Cancer
Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation
J Clin Oncol
The prognosis of primary intracerebral tumours presenting with epilepsy: the outcome of medical and surgical management
J Neurol Neurosurg Psychiatry
Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres
J Neurosurg
Survival of patients with well-differentiated astrocytomas diagnosed in the era of computed tomography
Neurosurgery
Supratentorial low-grade astrocytomas in adults
Neurosurgery
Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas
J Neurosurg
Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms
J Neurosurg
Prognostic significance of contrast enhancement in low-grade astrocytomas of the adult cerebrum
Radiology
Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma
J Neurosurg
Age and the risk of anaplasia in magnetic resonance-nonenhancing supratentorial cerebral tumors
Cancer
How often are nonenhancing supratentorial gliomas malignant? A population study
Neurology
Prognostic value positron emission tomography with [18F]fluoro-2-deoxy-D-glucose in the low-grade glioma
Neurosurgery
Clinical value of PET with 18F-fluorodeoxyglucose and L-methyl-11C-methionine for diagnosis of recurrent brain tumor and radiation injury
Acta Radiol
Serial evaluation of patients with brain tumors using volume MRI and 3D 1H MRSI
NMR Biomed
Low-grade gliomas
Low-grade cerebral astrocytomas. Survival and quality of life after radiation therapy
Cancer
Treatment and survival of low-grade astrocytoma in adults—1977-1988
Neurosurgery
Supratentorial low-grade astrocytoma. Correlation of computed tomography findings with effect of radiation therapy and prognostic variables
Cancer
Long-term prognosis of low grade astrocytoma
Zentralbl Neurochir
The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas
Cancer
Low grade supratentorial astrocytomas. Management and prognostic factors
Cancer
Prognostic factors in low-grade supratentorial astrocytomas: a uni- multivariate statistical analysis in 76 surgically treated adult patients
Surg Neurol
Observations on the current treatment of low-grade astrocytic tumors of the cerebral hemispheres
J Neurosurg
Low-grade pure and mixed cerebral astrocytomas treated in the CT scan era
J Neurooncol
5-year survival and clinical prognostic factors in progressive supratentorial diffuse “low-grade” astrocytoma: a retrospective analysis of 46 cases
Acta Neurochir
Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery
J Neurol Neurosurg Psychiatry
Clinical outcome of supratentorial astrocytoma WHO grade II
Acta Neurochir
Analysis of prognostic and survival factors related to treatment of low- grade astrocytomas in adults
Oncology
Adult brain low-grade astrocytomas: survival after surgery and radiotherapy
Neurol Sci
Cited by (138)
Stereotactic radiosurgery in the management of oligodendroglioma
2019, Oligodendroglioma: Clinical Presentation, Pathology, Molecular Biology, Imaging, and TreatmentTumor Volume Growth Rates and Doubling Times during Active Surveillance of IDH-mutant Low-Grade Glioma
2024, Clinical Cancer ResearchFully automated MR-based virtual biopsy of primary CNS lymphomas
2024, Neuro-Oncology Advances