Astrocytomas range from low-grade indolent tumors (the most prevalent) to malignant high-grade tumors. As a group, astrocytomas are the most common brain tumor in children Overview of Brain Tumors in Children Brain tumors are the most common solid cancer in children 15 years of age and are the 2nd leading cause of childhood death due to cancer. Diagnosis is typically by imaging (usually MRI) and... read more , representing about 40% of pediatric brain tumors. Most cases occur between the ages of 5 years and 9 years. These tumors can occur anywhere in the brain or spinal cord but are most common in the cerebellum.
Symptoms and Signs of Astrocytomas
Most patients have symptoms consistent with increased intracranial pressure (eg, morning headaches, vomiting, lethargy). Location of the tumor determines other symptoms and signs, for example
Cerebellum: Weakness, tremor, and ataxia
Visual pathway: Visual loss, proptosis, or nystagmus
Spinal cord: Pain, weakness, and gait disturbance
Diagnosis of Astrocytomas
Contrast-enhanced MRI
Biopsy
Contrast-enhanced MRI is the imaging test of choice for diagnosing the tumor, determining extent of disease, and detecting recurrence. Contrast-enhanced CT can also be used, although it is less specific and less sensitive.
Biopsy is needed for determining tumor type and grade. These tumors are typically classified as low grade (eg, juvenile pilocytic astrocytoma) or high grade (eg, glioblastoma— ). Many pathologists designate grades I and II tumors as low grade and grades III and IV tumors as high grade. However, because grade II tumors have a higher risk of relapse, some pathologists think these tumors should not be considered low grade.
Treatment of Astrocytomas
Surgical resection
Sometimes radiation therapy and/or chemotherapy
Treatment of astrocytoma depends on location and grade of tumor. As a general rule, the lower the grade of the tumor, the less intensive the therapy and the better the outcome.
Low grade: Surgical resection is the primary treatment, and total resection is the goal. Even after local recurrence, a second surgical resection can be beneficial depending on the location of the tumor. Radiation therapy is usually reserved for children who are > 10 years old and whose tumors are unresectable, cannot be completely excised, or progress/recur after surgery. For children < 10 years old whose tumors are unresectable or progress/recur after surgery, chemotherapy is used instead because radiation therapy may cause long-term cognitive impairment. Most children with low-grade astrocytomas are cured.
High grade: These tumors are treated with a combination of surgery (unless location precludes it), radiation therapy, and chemotherapy. Prognosis is poor; overall survival at 3 years is only 20 to 30%.
