Low-Grade Astrocytomas

  • Nader SanaiEmail author
  • Mitchel S Berger


Glial tumors constitute approximately 50% of newly diagnosed primary brain tumors, with low-grade gliomas (LGG) accounting for approximately 15% of all brain tumors in adults [21]. The subset of tumors classified as LGG represents a heterogeneous group of tumors with astrocytic, oligodendroglial, ependymal, or mixed cellular histologies. In the adult population, the term LGG typically refers to the diffuse, infiltrating variety of tumors classified as World Health Organization (WHO) grade II lesions—specifically low-grade astrocytomas, oligodendrogliomas, or mixed oligoastrocytomas [33]. Among low-grade astrocytomas, the most common his-tologic subtypes are the fibrillary, protoplasmic, and gemistocytic variants. There is no indication in the literature that LGGs are more prevalent in a specific ethnic or national group.


Cerebral Blood Volume Karnofsky Performance Score North Central Cancer Treatment Group Cerebellar Astrocytoma Gemistocytic Astrocytoma 
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  1. 1.
    Bauman G, Lote K, Larson D, et al (1999) Pretreatment factors predict overall survival for patients with low-grade glioma: a recursive partitioning analysis. Int J Radiat Oncol Biol Phys 45:923–929PubMedCrossRefGoogle Scholar
  2. 2.
    Bauman G, Pahapill P, Macdonald D, et al (1999) Low grade glioma: a measuring radiographic response to radiotherapy. The Can J Neurol Sci 26:18–22Google Scholar
  3. 3.
    Berger MS, Deliganis AV, Dobbins J, et al (1994) The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74:1784–1791PubMedCrossRefGoogle Scholar
  4. 4.
    Bernstein M, Parrent AG. (1994) Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 81:165–168PubMedCrossRefGoogle Scholar
  5. 5.
    Bloom HJ. (1982) Intracranial tumors: response and resistance to therapeutic endeavors, 1970–1980. Int J Radiat Oncol Biol Phys 8:1083–1113PubMedCrossRefGoogle Scholar
  6. 6.
    Bogler O, Huang HJ, Cavenee WK. (1995) Loss of wildtype p53 bestows a growth advantage on primary cortical astrocytes and facilitates their in vitro transformation. Cancer Res 55:2746–2751PubMedGoogle Scholar
  7. 7.
    Brada M, Viviers L, Abson C, et al (2003) Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol 14:1715–1721PubMedCrossRefGoogle Scholar
  8. 8.
    Brown PD, Buckner JC, O'Fallon JR, et al (2004) Importance of baseline mini-mental state examination as a prognostic factor for patients with low-grade glioma. Int J Radiat Oncol Biol Phys 59:117–125PubMedCrossRefGoogle Scholar
  9. 9.
    Cairncross JG, Ueki K, Zlatescu MC, et al (1998) Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90:1473–1479PubMedCrossRefGoogle Scholar
  10. 10.
    Cha S, Tihan T, Crawford F, et al (2005) Differentiation of low-grade oligodendrogliomas from low-grade astrocytomas by using quantitative blood-volume measurements derived from dynamic susceptibility contrast-enhanced MR imaging. AJNR Am J Neuroradiol 26:266–273PubMedGoogle Scholar
  11. 11.
    Chang EF, Potts MB, Keles GE, et al (2008) Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg 108:227–235PubMedCrossRefGoogle Scholar
  12. 12.
    Chang EF, Smith JS, Chang SM, et al (2008) The UCSF Low Grade Glioma Score: pre-operative prognostic classifi-cation for adult hemispheric low grade gliomas. Journal of Neurosurgery 109:817–824PubMedCrossRefGoogle Scholar
  13. 13.
    Claus EB, Horlacher A, Hsu L, et al (2005) Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 103:1227–1233PubMedCrossRefGoogle Scholar
  14. 14.
    Cunningham JM, Kimmel DW, Scheithauer BW, et al (1997) Analysis of proliferation markers and p53 expression in gliomas of astrocytic origin: relationships and prognostic value. J Neurosurg 86:121–130PubMedCrossRefGoogle Scholar
  15. 15.
    Davis FG, Malinski N, Haenszel W, et al (1996) Primary brain tumor incidence rates in four United States regions, 1985–1989: a pilot study. Neuroepidemiology 15:103–112PubMedCrossRefGoogle Scholar
  16. 16.
    Di Costanzo A, Scarabino T, Trojsi F, et al (2006) Multiparametric 3T MR approach to the assessment of cerebral gliomas: tumor extent and malignancy. Neuroradiology 48:622–631PubMedCrossRefGoogle Scholar
  17. 17.
    Di Costanzo A, Trojsi F, Giannatempo GM, et al (2006) Spectroscopic, diffusion and perfusion magnetic resonance imaging at 3.0 Tesla in the delineation of glioblastomas: preliminary results. J Exp Clin Cancer Res 25:383–390PubMedGoogle Scholar
  18. 18.
    Eyre HJ, Crowley JJ, Townsend JJ, et al (1993) A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: a Southwest Oncology Group study. J Neurosurg 78:909–914PubMedCrossRefGoogle Scholar
  19. 19.
    Fisher PG, Breiter SN, Carson BS, et al (2000) A clinico-pathologic reappraisal of brain stem tumor classification. Identification of pilocystic astrocytoma and fibrillary astro-cytoma as distinct entities. Cancer 89:1569–1576PubMedCrossRefGoogle Scholar
  20. 20.
    Franzini A, Leocata F, Cajola L, et al (1994) Low-grade glial tumors in basal ganglia and thalamus: natural history and biological reappraisal. Neurosurgery 35:817–820; discussion 820–811PubMedCrossRefGoogle Scholar
  21. 21.
    Guthrie BL, Laws ER, Jr. (1990) Supratentorial low-grade gliomas. Neurosurg Clin N Am 1:37–48PubMedGoogle Scholar
  22. 22.
    Hakyemez B, Erdogan C, Ercan I, et al (2005) High-grade and low-grade gliomas: differentiation by using perfusion MR imaging. Clin Radiol 60:493–502PubMedCrossRefGoogle Scholar
  23. 23.
    Hammoud MA, Ligon BL, elSouki R, et al (1996) Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging. J Neurosurg 84:737–741PubMedCrossRefGoogle Scholar
  24. 24.
    Hanzely Z, Polgar C, Fodor J, et al (2003) Role of early radiotherapy in the treatment of supratentorial WHO Grade II astrocytomas: long-term results of 97 patients. J Neurooncol 63:305–312PubMedCrossRefGoogle Scholar
  25. 25.
    Hoang-Xuan K, Capelle L, Kujas M, et al (2004) Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions. J Clin Oncol 22:3133–3138PubMedCrossRefGoogle Scholar
  26. 26.
    Ito S, Chandler KL, Prados MD, et al (1994) Proliferative potential and prognostic evaluation of low-grade astrocy-tomas. J Neurooncol 19:1–9PubMedCrossRefGoogle Scholar
  27. 27.
    James CD, Carlbom E, Nordenskjold M, et al (1989) Mitotic recombination of chromosome 17 in astrocytomas. Proc Natl Acad Sci USA 86:2858–2862PubMedCrossRefGoogle Scholar
  28. 28.
    Janny P, Cure H, Mohr M, et al (1994) Low grade supraten-torial astrocytomas. Management and prognostic factors. Cancer 73:1937–1945PubMedCrossRefGoogle Scholar
  29. 29.
    Jeremic B, Grujicic D, Antunovic V, et al (1994) Hyper-fractionated radiation therapy (HFX RT) followed by multiagent chemotherapy (CHT) in patients with malignant glioma: a phase II study. Int J Radiat Oncol Biol Phys 30:1179–1185PubMedCrossRefGoogle Scholar
  30. 30.
    Jeun SS, Kim MC, Kim BS, et al (2005) Assessment of malignancy in gliomas by 3T 1H MR spectroscopy. Clin Imaging 29:10–15PubMedCrossRefGoogle Scholar
  31. 31.
    Johannesen TB, Langmark F, Lote K. (2003) Progress in long-term survival in adult patients with supratentorial low-grade gliomas: a population-based study of 993 patients in whom tumors were diagnosed between 1970 and 1993. J Neurosurg 99:854–862PubMedCrossRefGoogle Scholar
  32. 32.
    Karim AB, Maat B, Hatlevoll R, et al (1996) 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 36:549–556PubMedCrossRefGoogle Scholar
  33. 33.
    Kleihues P, Cavenee WK. (2000) Pathology and genetics of tumours of the nervous system. IARC Press, LyonGoogle Scholar
  34. 34.
    Laack NN, Brown PD, Ivnik RJ, et al (2005) Cognitive function after radiotherapy for supratentorial low-grade glioma: a North Central Cancer Treatment Group prospective study. Int J Radiat Oncol Biol Phys 63:1175–1183PubMedCrossRefGoogle Scholar
  35. 35.
    Laws ER, Jr., Taylor WF, Bergstralh EJ, et al (1986) The neurosurgical management of low-grade astrocytoma. Clin Neurosurg 33:575–588PubMedGoogle Scholar
  36. 36.
    Leighton C, Fisher B, Bauman G, et al (1997) Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncology 15:1294–1301Google Scholar
  37. 37.
    Levin N, Lavon I, Zelikovitsh B, et al (2006) Progressive low-grade oligodendrogliomas: response to temozolomide and cor- relation between genetic profile and O6-methylguanine DNA methyltransferase protein expression. Cancer 106:1759–1765PubMedCrossRefGoogle Scholar
  38. 38.
    Lote K, Egeland T, Hager B, et al (1997) Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol 15:3129–3140PubMedGoogle Scholar
  39. 39.
    Lunsford LD, Somaza S, Kondziolka D, et al (1995) Brain astrocytomas: biopsy, then irradiation. Clin Neurosurg 42:464–479PubMedGoogle Scholar
  40. 40.
    Lunsford LD, Somaza S, Kondziolka D, et al (1995) Survival after stereotactic biopsy and irradiation of cerebral nonana-plastic, nonpilocytic astrocytoma. J Neurosurg 82:523–529PubMedCrossRefGoogle Scholar
  41. 41.
    Magalhaes A, Godfrey W, Shen Y, et al (2005) Proton magnetic resonance spectroscopy of brain tumors correlated with pathology. Acad Radiol 12:51–57PubMedCrossRefGoogle Scholar
  42. 42.
    McCormack BM, Miller DC, Budzilovich GN, et al (1992) Treatment and survival of low-grade astrocytoma in adults — 1977–1988. Neurosurgery 31:636–642; discussion 642PubMedCrossRefGoogle Scholar
  43. 43.
    McKnight TR, Lamborn KR, Love TD, et al (2007) Correlation of magnetic resonance spectroscopic and growth characteristics within Grades II and III gliomas. J Neurosurg 106:660–666PubMedCrossRefGoogle Scholar
  44. 44.
    Minn H. (2005) PET and SPECT in low-grade glioma. Eur J Radiol 56:171–178PubMedCrossRefGoogle Scholar
  45. 45.
    Muller W, Afra D, Schroder R. (1977) Supratentorial recurrences of gliomas. Morphological studies in relation to time intervals with astrocytomas. Acta Neurochir (Wien) 37:75–91CrossRefGoogle Scholar
  46. 46.
    Nakamura M, Konishi N, Tsunoda S, et al (2000) Analysis of prognostic and survival factors related to treatment of low-grade astrocytomas in adults. Oncology 58:108–116PubMedCrossRefGoogle Scholar
  47. 47.
    Nakamura T, Hirato J, Hotchi M, et al (1990) Astrocytoma with granular cell tumor-like changes. Report of a case with histochemical and ultrastructural characterization of granular cells. Acta Pathol Jpn 40:206–211PubMedGoogle Scholar
  48. 48.
    Nicolato A, Gerosa MA, Fina P, et al (1995) Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients. Surgical neurology 44:208–221; discussion 221–203PubMedCrossRefGoogle Scholar
  49. 49.
    North CA, North RB, Epstein JA, et al (1990) Low-grade cerebral astrocytomas. Survival and quality of life after radiation therapy. Cancer 66:6–14PubMedCrossRefGoogle Scholar
  50. 50.
    Peraud A, Ansari H, Bise K, et al (1998) Clinical outcome of supratentorial astrocytoma WHO grade II. Acta Neuro-chirurgica 140:1213–1222CrossRefGoogle Scholar
  51. 51.
    Perry A, Jenkins RB, O'Fallon JR, et al (1999) Clinico-pathologic study of 85 similarly treated patients with anaplastic astrocytic tumors. An analysis of DNA content (ploidy), cellular proliferation, and p53 expression. Cancer 86:672–683PubMedCrossRefGoogle Scholar
  52. 52.
    Philippon JH, Clemenceau SH, Fauchon FH, et al (1993) Supratentorial low-grade astrocytomas in adults. Neurosurgery 32:554–559PubMedCrossRefGoogle Scholar
  53. 53.
    Piepmeier J, Christopher S, Spencer D, et al (1996) Variations in the natural history and survival of patients with supratento-rial low-grade astrocytomas. Neurosurgery 38:872–878; discussion 878–879PubMedCrossRefGoogle Scholar
  54. 54.
    Piepmeier JM. (1987) Observations on the current treatment of low-grade astrocytic tumors of the cerebral hemispheres. J Neurosurg 67:177–181PubMedCrossRefGoogle Scholar
  55. 55.
    Pignatti F, van den Bent M, Curran D, et al (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:2076–2084PubMedCrossRefGoogle Scholar
  56. 56.
    Pouratian N, Gasco J, Sherman JH, et al (2007) Toxicity and efficacy of protracted low dose temozolomide for the treatment of low grade gliomas. J Neurooncol 82:281–288PubMedCrossRefGoogle Scholar
  57. 57.
    Practice parameters in adults with suspected or known supratentorial nonoptic pathway low-grade glioma. (1998) Neurosurg Focus 4:e10Google Scholar
  58. 58.
    Price SJ, Jena R, Burnet NG, et al (2006) Improved delineation of glioma margins and regions of infiltration with the use of diffusion tensor imaging: an image-guided biopsy study. AJNR Am J Neuroradiol 27:1969–1974PubMedGoogle Scholar
  59. 59.
    Price SJ, Pena A, Burnet NG, et al (2004) Detecting glioma invasion of the corpus callosum using diffusion tensor imaging. Br J Neurosurg 18:391–395PubMedCrossRefGoogle Scholar
  60. 60.
    Rajan B, Pickuth D, Ashley S, et al (1994) The management of histologically unverified presumed cerebral gliomas with radiotherapy. Int J Radiat Oncol Biol Phys 28:405–413PubMedCrossRefGoogle Scholar
  61. 61.
    Recht LD, Lew R, Smith TW. (1992) Suspected low-grade glioma: is deferring treatment safe? Ann Neurol 31:431–436PubMedCrossRefGoogle Scholar
  62. 62.
    Reifenberger J, Reifenberger G, Liu L, et al (1994) Molecular genetic analysis of oligodendroglial tumors shows preferential allelic deletions on 19q and 1p. Am J Pathol 145:1175–1190PubMedGoogle Scholar
  63. 63.
    Rey JA, Bello MJ. (1999) Cytogenetics. In: Berger MS, Wilsons CW (eds) The gliomas. W.B. Saunders, Philadelphia, PA, pp. 25–37Google Scholar
  64. 64.
    Sanai N, Alvarez-Buylla A, Berger MS. (2005) Neural stem cells and the origin of gliomas. N Engl J Med 353:811–822PubMedCrossRefGoogle Scholar
  65. 65.
    Sanai N, Berger MS. (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62:753–764; discussion 264–756PubMedCrossRefGoogle Scholar
  66. 66.
    Sanai N, Mirzadeh Z, Berger MS. (2008) Functional outcome after language mapping for glioma resection. N Engl J Med 358:18–27PubMedCrossRefGoogle Scholar
  67. 67.
    Scerrati M, Roselli R, Iacoangeli M, et al (1996) Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery. J Neurol Neurosurg Psychiatry 61:291–296PubMedCrossRefGoogle Scholar
  68. 68.
    Schiff D. (2007) Temozolomide and radiation in low-grade and anaplastic gliomas: temoradiation. Cancer Invest 25:776–784PubMedCrossRefGoogle Scholar
  69. 69.
    Schiffer D, Cavalla P, Chio A, et al (1997) Proliferative activity and prognosis of low-grade astrocytomas. J Neurooncol 34:31–35PubMedCrossRefGoogle Scholar
  70. 70.
    Shafqat S, Hedley-Whyte ET, Henson JW. (1999) Age-dependent rate of anaplastic transformation in low-grade astrocytoma. Neurology 52:867–869PubMedCrossRefGoogle Scholar
  71. 71.
    Shaw E, Arusell R, Scheithauer B, et al (2002) Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 20:2267–2276PubMedCrossRefGoogle Scholar
  72. 72.
    Shibamoto Y, Kitakabu Y, Takahashi M, et al (1993) Supratentorial low-grade astrocytoma. Correlation of computed tomography findings with effect of radiation therapy and prognostic variables. Cancer 72:190–195PubMedCrossRefGoogle Scholar
  73. 73.
    Shimizu H, Kumabe T, Tominaga T, et al (1996) Noninvasive evaluation of malignancy of brain tumors with proton MR spectroscopy. AJNR Am J Neuroradiol 17:737–747PubMedGoogle Scholar
  74. 74.
    Smith JS, Chang EF, Lamborn KR, et al (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345PubMedCrossRefGoogle Scholar
  75. 75.
    Soffietti R, Chio A, Giordana MT, et al (1989) Prognostic factors in well-differentiated cerebral astrocytomas in the adult. Neurosurgery 24:686–692PubMedCrossRefGoogle Scholar
  76. 76.
    Szymanski MD, Rowley HA, Roberts TP. (1999) A hemi-spherically asymmetrical MEG response to vowels. Neuroreport 10:2481–2486PubMedCrossRefGoogle Scholar
  77. 77.
    Taphoorn MJ, Schiphorst AK, Snoek FJ, et al (1994) Cognitive functions and quality of life in patients with low-grade gliomas: the impact of radiotherapy. Ann Neurol 36:48–54PubMedCrossRefGoogle Scholar
  78. 78.
    Tihan T, Davis R, Elowitz E, et al (2000) Practical value of Ki-67 and p53 labeling indexes in stereotactic biopsies of diffuse and pilocytic astrocytomas. Arch Pathol Lab Med 124:108–113PubMedGoogle Scholar
  79. 79.
    van den Bent MJ, Afra D, de Witte O, et al (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366:985–990PubMedCrossRefGoogle Scholar
  80. 80.
    van Veelen ML, Avezaat CJ, Kros JM, et al (1998) Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 64:581–587PubMedCrossRefGoogle Scholar
  81. 81.
    Vertosick FT, Jr., Selker RG, Arena VC. (1991) Survival of patients with well-differentiated astrocytomas diagnosed in the era of computed tomography. Neurosurgery 28:496–501PubMedCrossRefGoogle Scholar
  82. 82.
    Watanabe K, Sato K, Biernat W, et al (1997) Incidence and timing of p53 mutations during astrocytoma progression in patients with multiple biopsies. Clin Cancer Res 3:523–530PubMedGoogle Scholar
  83. 83.
    Whitton AC, Bloom HJ. (1990) Low grade glioma of the cerebral hemispheres in adults: a retrospective analysis of 88 cases. Int J Radiat Oncol Biol Phys 18:783–786PubMedCrossRefGoogle Scholar
  84. 84.
    Woodworth GF, McGirt MJ, Samdani A, et al (2006) Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 104:233–237PubMedCrossRefGoogle Scholar
  85. 85.
    Yahanda AM, Bruner JM, Donehower LA, et al (1995) Astrocytes derived from p53-deficient mice provide a multistep in vitro model for development of malignant gliomas. Mol Cell Biol 15:4249–4259PubMedGoogle Scholar
  86. 86.
    Yeh SA, Ho JT, Lui CC, et al (2005) Treatment outcomes and prognostic factors in patients with supratentorial low-grade gliomas. Br J Radiol 78:230–235PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of California at San FranciscoSan FranciscoUSA

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