Of 514 patients diagnosed with brain tumor between 1972 and 2003 at Hacettepe University, Ankara, Turkey, 98 had astrocytic tumors; 56% were grade I-II and 44% were grade III-IV. The age range was 1-16 years (median 9 years), and the male/female ratio 1.13. Tumors were supratentorial in 52%, infratentorial in 38%, and medullo-spinal in 10%. Chemotherapy was used in 47 patients. Overall survival (OS) rate was 59% at a median follow-up of 62 months. OS rates were 93% for grade I-II and 22% for grade III-IV astrocytomas; 77% for posterior fossa tumors, 48% for supratentorial, and 58% for spinal tumors. Gross total resection of grade III and IV tumors yielded longer survival times (p=0.003). Survival rate was not affected by resection of grade I and II tumors, and outcome was not related to age, or type of chemotherapeutic regimen. Postoperative radiotherapy was used in the majority of patients (84%) and its value could not be defined statistically. Low grade astrocytomas are highly responsive to surgery and do not require further treatment unless relapse occurs. [1]

COMMENT. Surgery is the treatment of choice for grade I-II astrocytomas, and total resection is advised when possible. Chemotherapy is the treatment of choice in patients under 3 years of age and in relapsed grade I-II patients. Radiotherapy is of no benefit in patients with totally resected low-grade tumors.