Low-grade astrocytoma in adults

Edward J Dropcho MD (Dr. Dropcho of Indiana University Medical Center has no relevant financial relationships to disclose.)
Originally released February 10, 1997; last updated January 22, 2013; expires January 22, 2016
Notice: This article has expired and is therefore not available for CME credit.


Supratentorial astrocytoma most often presents as a seizure in an otherwise healthy young adult. "Low-grade" astrocytomas have a better prognosis than anaplastic gliomas, but they are clearly not benign as most patients succumb within 10 years. The author summarizes the basic biology, clinical features, and evolving treatment options for patients with astrocytoma.

Key points


• Low-grade "diffuse" astrocytomas comprise 10% to 15% of cerebral gliomas in adults.


• Astrocytoma most commonly presents with the new onset of seizure(s) in a young adult and a nonenhancing lesion on MRI scan.


• The main treatment options for patients with astrocytoma are surgical resection and/or radiation therapy. In selected patients, it may be reasonable to defer intervention.


• Astrocytoma carries a better survival prognosis than anaplastic glioma, but it is not a benign neoplasm, and treatment is rarely curative. In most (not all) patients, the tumor eventually undergoes transformation to anaplastic astrocytoma or glioblastoma.

Historical note and terminology

The term "low-grade" is classically applied to a glioma that grows slowly and usually infiltrates adjacent brain tissue without possessing significant histologic anaplasia. Consequently, the term has an implied prognostic significance. Kernohan and Sayre proposed using a grading system for astrocytomas indicative not only of the histology, but also of the prognosis of these tumors (Kernohan and Sayre 1952). Currently, the classification scheme most often used is that of the World Health Organization (von Deimling et al 2007), which subdivides astrocytic neoplasms into grade 1 (pilocytic astrocytoma), grade 2 ("low-grade" or "diffuse" astrocytoma), grade 3 (anaplastic astrocytoma), and grade 4 (glioblastoma).

Several other "low-grade" gliomas differ from astrocytomas in their clinical presentation, histopathology, and clinical outcome. These tumors include oligodendroglioma, pilocytic astrocytoma, brainstem glioma, ganglioglioma, dysembryoplastic neuroepithelial tumor, central neurocytoma, and pleomorphic xanthoastrocytoma. This review will focus only on supratentorial World Health Organization grade 2 astrocytomas in adults.

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