title: Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord.
abstract: OBJECTIVE
  To determine survival and changes in neurologic function and Karnofsky performance status (KPS) in a series of patients treated for low-grade astrocytoma of the spinal cord during the past two decades.
  
  
  METHODS
  This study consisted of 14 patients with pathologically confirmed low-grade astrocytoma of the spinal cord who were treated between 1980 and 2003. All patients underwent decompressive laminectomy followed by biopsy (n = 7), subtotal resection (n = 6), or gross total resection (n = 1). Ten patients underwent postoperative radiotherapy (median total dose 50 Gy in 28 fractions). The overall survival, progression-free survival, and changes in neurologic function and KPS were measured.
  
  
  RESULTS
  The overall survival rate at 5, 10, and 20 years was 100%, 75%, and 60%, respectively. The progression-free survival rate at 5, 10, and 20 years was 93%, 80%, and 60%, respectively. Neither overall survival nor progression-free survival was clearly correlated with any patient, tumor, or treatment factors. Neurologic function and KPS worsened after surgery in 8 (57%) of 14 and 9 (69%) of 13 patients, respectively. At a mean follow-up of 10.2 years, neurologic function had stabilized or improved in 8 (73%) of 11 remaining patients, but the KPS had worsened in 5 (50%) of 10. Most patients who were employed before surgery were working at last follow-up.
  
  
  CONCLUSIONS
  Patients who undergo gross total resection of their tumor may be followed closely. Patients who undergo limited resection should continue to receive postoperative RT (50.4 Gy in 1.8-Gy fractions). The functional measures should be routinely evaluated to appreciate the treatment outcomes.
authors.affiliation: Department of Radiation Oncology, Brain Tumor Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Clifford G
authors.initials: CG
authors.lastname: Robinson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prayson
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Hahn
authors.forename: Iain H
authors.initials: IH
authors.lastname: Kalfas
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Whitfield
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Lee
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000401:mortality* / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D013120:Spinal Cord Neoplasms / Q000401:mortality* / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery; D015996:Survival Rate; D017211:Treatment Failure