Type of Tumor 5-Year Relative Survival Rate

Age
20-44 45-54 55-64
Low-grade (diffuse) astrocytoma 65% 43% 21%

Anaplastic astrocytoma 49% 29% 10%

Glioblastoma 17% 6% 4%

Oligodendroglioma 85% 79% 64%

Anaplastic oligodendroglioma 67% 55% 38%

Ependymoma/anaplastic 91% 86% 85%

ependymoma

Meningioma 92% 77% 67%

Astrocytomas
Astrocytomas can be slow growing (grade 1 or 2) or fast growing (grade 3 or 4). Grade 3 is
called anaplastic astrocytoma. Grade 4 is very fast growing and is called glioblastoma
multiforme or GBM.

The prognosis for glioma depends on many factors including

The grade of the tumour

Where in the brain the glioma is

Whether the tumour can be removed surgically

Age

How the tumour affects day to day functions such as thinking, memory and moving
around

Certain changes in genes within the tumour

 Whether the tumour responds to radiotherapy or chemotherapy

Grade 1 astrocytomas (eg pilocystic astrocytomas) can often be completely removed with
surgery and have a very good outlook although some tumours may come back. The outlook can
also be good for grade 2 tumours (eg diffuse astrocytoma) - although it is usually not possible to
remove them completely. More than 40 out of 100 (40%) of people diagnosed with a grade 2
astrocytoma survive for 10 years or more after diagnosis. Low grade tumours in adults may
change into high grade tumours (transform) after some time though.

A large US study showed that for grade 3 astrocytomas (anaplastic astrocytoma) more than 25
out of 100 people diagnosed (25%) survive for 5 years or more after diagnosis.

Unfortunately, the outlook is not so good for people with the most quickly growing astrocytomas
(grade 4 glioblastoma multiforme GBM). Many people live for less than a year. Around 6 in
100 people (6%) survive for 5 years or more after diagnosis. People who have a particular gene
called MGMT turned off (methylated) in their tumour cells tend to live longer and respond better
to certain types of chemotherapy. Just over 1 in 3 people with glioblastoma multiforme have this
gene change. For a person under the age of 50, with no disability, an MGMT methylated GBM,
who has had surgery where the surgeon has ben able to remove 90% of the tumour or more, has
around a 2 in 3 chance of being alive at 2 years.

Meningioma

About a quarter (25%) of all brain tumours are meningiomas. They are grouped into 3 grades

Slow growing (benign or low grade)

Intermediate grade (atypical or grade 2)

Aggressive (anaplastic or high grade)

It is usually possible to remove these tumours but this depends on their position in the brain.

Meningiomas are mostly slowly growing (low grade). Around 80 out of 100 (80%) people with
this type of meningioma will survive for 5 years or more after diagnosis. Even if a slow growing
meningioma cannot be completely removed, it may not grow for a long time.

High grade, anaplastic meningiomas are more likely to come back after surgery and doctors may
recommend radiotherapy for grade 2 and 3 tumours. About a third of the tumours that are
completely removed will come back if they are not treated with radiotherapy after surgery. Fewer
than 60 out of 100 people (60%) with a high grade meningioma will survive for 5 years or more
after diagnosis.

Meningiomas are rare in children. They may occur in children who have neurofibomatosis and
tend to start in the lining of the fluid filled spaces in the brain (the ventricles). Unfortunately they
tend to be the more quickly growing type. Treatment aims to remove the whole tumour and
doctors may suggest radiotherapy after surgery for grade 3 tumours.
WHO
Astrocytomas Description
Grade

Pilocytic astrocytoma
Consist of slow growing astrocytomas, benign, and
Pleomorphic associated with long-term survival. Individuals with
xanthoastrocytoma very slow growing tumors where complete surgical
I removal by stereotactic surgery is possible may
Subependymal giant experience total remission. Even if the surgeon is not
cell astrocytoma able to remove the entire tumor, it may remain inactive
Subependymoma or be successfully treated with radiation.

Consist of relatively slow-growing astrocytomas,

usually considered benign that sometimes evolve into
more malignant or as highergrade tumors. They are
prevalent in younger people who often present with
seizures. Median survival varies with the cell type of
the tumor. Grade 2 astrocytomas are defined as being
invasive gliomas, meaning that the tumor cells
penetrate into the surrounding normal brain, making a
Low-grade surgical cure more difficult. People
(fibrillary) with oligodendrogliomas (which might share common
astrocytoma cells of origin have better prognoses than those with
II
mixed oligoastrocytomas, who in turn have better
Mixed prognoses than patients with (pure) low-grade
oligoastrocytoma astrocytomas. Other factors which influence survival
include age (younger the better) and performance
status (ability to perform tasks of daily living). Due to
the infiltrative nature of these tumors, recurrences are
relatively common. Depending on the patient, radiation
or chemotherapy after surgery is an option. Individuals
with grade 2 astrocytoma have a 5-year survival rate of
about 34% without treatment and about 70% with
radiation therapy.The median survival time is 4 years.

III Anaplastic astrocytoma Consist of anaplastic astrocytomas. It is often related

to seizures, neurologic deficits, headaches, or changes
in mental status. The standard initial treatment is to
remove as much of the tumor as possible without
 worsening neurologic deficits. Radiation therapy has
been shown to prolong survival and is a standard
component of treatment. Individuals with grade 3
astrocytoma have a median survival time of 18 months
without treatment (radiation and chemotherapy).There
is no proven benefit to adjuvant chemotherapy or
supplementing other treatments for this kind of tumor.
Although temozolomide is effective for treating
recurrent anaplastic astrocytoma, its role as an
adjuvant to radiation therapy has not been fully tested.

Consists of Glioblastoma multiforme (GBM), which is

the most common and most malignant primary brain
tumor. Primary GBM grow and spread to other parts of
the brain quickly; they can become very large before
producing symptoms, which often begin abruptly with
seizures.Less than 10% form more slowly following
degeneration of low-grade astrocytoma or anaplastic
astrocytoma. These are called secondary GBM and are
more common in younger patients (mean age 45 versus
62 years).Surgical removal remains the mainstay of
treatment, provided that unacceptable neurologic
Glioblastoma injury can be avoided. The extremely infiltrative nature
IV
multiforme (GBM) of this tumor makes complete surgical removal
impossible. Although radiotherapy rarely cures
glioblastoma, studies show that it doubles the median
survival of patients, compared to supportive care
alone. The prognosis is worst for these grade 4
gliomas. Few patients survive beyond 3 years.
Individuals with grade 4 astrocytoma have a median
survival time of 17 weeks without treatment,
30[2] weeks with radiation, and 37 weeks with surgical
removal of most of the tumor followed by radiation
therapy. Long-term survival (at least five years) falls
well under 3%.
Daftar Pustaka:
1. Louis DN, Ohgaki H, Wiestler OD, et al., eds.: WHO Classification of Tumours of the
Central Nervous System. 4th ed. Lyon, France: IARC Press, 2007.
2. Pollack IF: Brain tumors in children. N Engl J Med 331 (22): 1500-7, 1994. [PUBMED
Abstract]

3. Kolegium Neurologi Indonesia. 2008. Modul Neurobehavior: Bagian II Gangguan

Neurobehavior. Hal: 54-55.