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. 
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.