Chaskis Elly, Silvestri Martina, Aghakhani Nozar, Parker Fabrice, Knafo Steven
Department of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, France.
Faculty of Medicine, University Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.
Cancers (Basel). 2024 Jun 30;16(13):2417. doi: 10.3390/cancers16132417.
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 ( = 0.14) and PFS ( = 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（IMAs）是成人中第二常见的髓内肿瘤。低级别IMAs（LG-IMAs，世界卫生组织I级和II级）的预后优于高级别IMAs（HG-IMAs）。然而，LG-IMAs的辅助放疗（RT）和/或化疗（CT）以及肿瘤复发的治疗仍存在争议。我们研究的目的是评估LG-IMAs的术后结果以及复发性肿瘤的管理。我们回顾性分析了1980年至2022年在单一神经外科接受IMA手术的一系列患者。我们检索到40例接受髓内星形细胞瘤手术的患者，其中包括30例LG-IMAs（22例世界卫生组织I级；5例世界卫生组织II级；3例“低级别”）和10例HG-IMAs（4例世界卫生组织III级；5例世界卫生组织IV级；1例“高级别”）。在LG-IMAs患者中，30%的病例手术切除范围较大（大体或次全切除>90%）。仅对接受活检的患者（n = 5）建议术后立即进行放疗和/或化疗，而其他患者最初进行随访。中位随访59个月（范围 = 13 - 376个月），16例LG-IMA（53.3%）复发，术后平均延迟28.5个月（范围 = 3 - 288个月）。其中包括7例活检、5例部分切除（PR）、4例次全切除（STR），但无大体全切除（GTR）。LG-IMAs的无进展生存期在3年时为51.9%，在5年和10年时分别为35.6%；总生存期在3年时为96.3%，在5年时为90.9%，在10年时为81.9%。世界卫生组织I级和II级肿瘤在总生存期（OS）和无进展生存期（PFS）方面无显著差异。然而，与“有限切除（PR和活检）”相比，“大切除（GTR或STR）”与更好的OS（P = 0.14）和PFS（P = 0.04）相关。复发性肿瘤治疗包括单纯手术（n = 3）、手术联合RT和/或CT（n = 2）、RT联合CT（n = 3）、单纯RT（n = 2）或单纯CT（n = 2）。总之，尽管LG-IMAs是浸润性肿瘤，但切除范围（GTR或STR）而非世界卫生组织分级是主要预后因素。复发性肿瘤的管理差异很大，两种选择均无确凿证据。
