Prognostic Factors in Management of Primary Spinal Cord Astrocytoma in Children

Keywords: children, risk factor, outcome, spinal cord, astrocytoma

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     Astrocytomas are the most common primary intramedullary spinal neoplasms in children.
     Scant data exists regarding prognostic factors and efficacy of treatment modalities.
     This IRB-approved study retrospectively reviewed 38 children with primary spinal astrocytomas presenting from June 1981 to June 2011.
     Multi-factorial analyses examined the following factors’ prognostic value on progression-free survival: symptom type and duration; tumor location, size, and grade; extent of resection; chemotherapy; and radiation.
     Tumors included 5 pilocytic astrocytomas, 20 low-grade astrocytomas, and 13 anaplastic astrocytomas. 14 patients received biopsy only, 17 underwent partial resection, and 7 had gross total resection. Median age at resection was 124 months (range 16-204). Median follow-up was 45 months (range 1-396). 16 children received chemotherapy. 22 received radiation. Overall and progression-free survivals were 94.7% and 71.1% respectively at 6 months. Anaplastic astrocytomas and age over 7 years independently had significantly worse progression-free survival (p = 0.003, p = 0.008 respectively). Extent of resection showed benefit in low-grade tumors only (p = 0.048).
     This is a retrospective study.
     Anaplastic histology and age over 7 were associated with worse progression-free survival.
     Extent of resection was associated with increased progression-free survival in low-grade tumors.


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