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Surgical strategy in grade II astrocytoma: a population-based analysis of survival and morbidity with a strategy of early resection as compared to watchful waiting

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

We recently demonstrated a survival benefit of early resection in unselected diffuse low-grade gliomas (LGG). However, heterogeneity within the LGG entity warrants investigation in a homogenous subgroup. Astrocytoma represents the largest subgroup of LGG, and is characterized by diffuse growth and inferior prognosis. We aimed to study the effects of early resection compared to biopsy and watchful waiting in this subgroup.

Methods

Patient data was retrospectively reviewed in two neurosurgical departments with regional referral practice. In one hospital, initial diagnostic biopsies and watchful waiting was favored, while early resections guided with three-dimensional (3D) ultrasound were advocated in the other hospital. This created a natural experiment with patient management heavy influenced by residential address. In the hospitals’ histopathology databases, all adult patients diagnosed with supratentorial LGG from 1998 through 2009 were screened (n = 169) and underwent blinded histopathological review. Histopathological review concluded with 117 patients with grade II astrocytomas that were included in the present study. The primary end-point was overall survival assessed by a regional comparison.

Results

Early resections were performed in 51 (82 %) versus 12 (22 %) patients in the respective hospitals (p < 0.001). The two patient populations were otherwise similar. Median survival was 9.7 years (95 % CI 7.5–11.9) if treated in the hospital favoring early resections compared to 5.6 years (95 % CI 3.5–7.6) if treated at the hospital favoring biopsy and watchful waiting (p = 0.047). No difference in surgical-related neurological morbidity was seen (p = 0.843).

Conclusions

Early 3D ultrasound guided resections improve survival, apparently without increased morbidity, compared to biopsy and watchful waiting in patients with diffuse World Health Organization (WHO) grade II astrocytomas.

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Acknowledgments

We would like to thank Anne-Lise Furnes and Lisa M. Sagberg for facilitating this research project by assisting in data collection. This help was provided without any form of compensation.

Funding

None.

Conflict of interest

Geirmund Unsgård has approximately 0.3 % of the stocks in SonoWand. SonoWand is the company that makes the 3D ultrasound-based intraoperative imaging system (SonoWand®) used in the resections at the hospital favoring early resections. None of the other authors have any conflicts of interest to declare.

Statement

This paper is in part a subgroup analysis based on a previous publication in JAMA (reference #11).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, St.Olavs University Hospital, N-7006, Trondheim, Norway

    Asgeir Store Jakola, Geirmund Unsgård, Ole Kristian Losvik & Ole Solheim

  2. MI Lab, Norwegian University of Science and Technology, N-7006, Trondheim, Norway

    Asgeir Store Jakola

  3. Department of Neuroscience, Norwegian University of Science and Technology, N-7006, Trondheim, Norway

    Asgeir Store Jakola & Geirmund Unsgård

  4. National Centre for ultrasound and image guided therapy, N-7006, Trondheim, Norway

    Asgeir Store Jakola, Geirmund Unsgård & Ole Solheim

  5. Department of Pathology, University Hospital of Northern Norway, N-9019, Tromsø, Norway

    Kristin Smistad Myrmel & Sigurd Lindal

  6. Department of Ophthalmology and Neurosurgery, University Hospital of Northern Norway, N-9019, Tromsø, Norway

    Roar Kloster

  7. Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, N-7006, Trondheim, Norway

    Sverre Helge Torp

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  1. Asgeir Store Jakola
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Correspondence to Asgeir Store Jakola.

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Jakola, A.S., Unsgård, G., Myrmel, K.S. et al. Surgical strategy in grade II astrocytoma: a population-based analysis of survival and morbidity with a strategy of early resection as compared to watchful waiting. Acta Neurochir 155, 2227–2235 (2013). https://doi.org/10.1007/s00701-013-1869-8

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  • DOI: https://doi.org/10.1007/s00701-013-1869-8

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