Comprehensive Review of Astrocytoma: Epidemiology, Molecular Classification, Diagnosis, Surgical Management, Adjuvant Therapies, and Prognosis
DOI:
https://doi.org/10.63666/ejsmr.1694-9013.4.I.2026.99Keywords:
astrocytoma, extent of resection, glioblastoma, gliomaAbstract
Background: Astrocytomas constitute the most prevalent group of primary brain neoplasms arising from astrocytic glial cells. The 2021 World Health Organization (WHO) Classification of Tumours of the Central Nervous System (CNS) introduced a paradigm shift by integrating molecular diagnostics with histopathology, fundamentally reorganising how astrocytomas are defined, graded, and managed.
Objectives: To provide a comprehensive, evidence-based synthesis of astrocytoma epidemiology, molecular pathogenesis, diagnosis, surgical management, adjuvant therapies, prognosis, and emerging trends, integrating contemporary original research.
Methods: A systematic literature search was conducted across PubMed/MEDLINE, Scopus, and Cochrane Library. Priority was given to high-quality original studies, systematic reviews, and meta-analyses.
Results: Extent of surgical resection (EOR) is the most consistently demonstrated independent prognostic factor across all astrocytoma grades. For anaplastic astrocytoma (grade 3), GTR conferred significantly improved overall survival versus subtotal resection or biopsy in both retrospective and systematic review analyses. Case-based evidence in glioblastoma further reinforces the survival impact of maximal resection.
Conclusion: Astrocytoma management demands individualised, molecularly guided, and surgically aggressive strategies.
References
1. Chaulagain D, Smolanka V, Smolanka A. Diagnosis and Management of Astrocytoma: A Literature Review. International Neurological Journal. 2022;18(1):23-29. doi:10.22141/2224-0713.18.1.2022.925
2. Chaulagain D, Smolanka V, Smolanka A. Pilocytic Astrocytoma: A Literature Review. International Neurological Journal. 2022;18(3):39-45. doi:10.22141/2224-0713.18.3.2022.942
3. Chaulagain D, Smolanka V, Smolanka A. A Comprehensive Review of Low-Grade Diffuse Astrocytoma: Characteristics, Molecular Classification and Surgical Treatment. International Neurological Journal. 2022;18(4):39-45. doi:10.22141/2224-0713.18.4.2022.957
4. Chaulagain D, Smolanka V, Smolanka A, Munakomi S, Havryliv T. The Role of Extent of Resection on the Prognosis of Low-Grade Astrocytoma: A Systematic Review and Meta-Analysis. Egyptian Journal of Neurosurgery. 2022;37:19. doi:10.1186/s41984-022-00161-1
5. Chaulagain D, Smolanka V, Smolanka A, Havryliv T. Do Extent of Resection and Tumor Volume Affect the Overall Survival of Anaplastic Astrocytoma? A Retrospective Study from a Single Center. Open Access Macedonian Journal of Medical Sciences. 2022;10(B):2060-2064. doi:10.3889/oamjms.2022.10697
6. Chaulagain D, Smolanka V, Smolanka A, Havryliv T. The Impact of Extent of Resection on the Long-Term Surgical Outcome of Grade II Diffuse Astrocytoma: A Retrospective Study. International Neurological Journal. 2023;19(1). doi:10.22141/2224-0713.19.1.2023
7. Chaulagain D, Smolanka V, Smolanka A, Munakomi S. Impact of Gross-Total Resection Versus Other Extent of Resections for the Overall Survival of Anaplastic Astrocytoma: A Systematic Literature Review. Romanian Neurosurgery. 2023;37(3):333-339. doi:10.33962/roneuro-2023-060
8. Chaulagain D, Smolanka V, Smolanka A, Havryliv T. Glioblastoma: A Literature Review. International Neurological Journal. 2023;19(2). [Uzhhorod National University, Ukraine]
9. Chaulagain D, Smolanka V, Smolanka A, Havryliv T. Case Report: Impact of Gross Total Resection on Survival in Glioblastoma. F1000Research. 2024;13:487. doi:10.12688/f1000research.150065.1
10. Chaulagain D, Smolanka V, Smolanka A, Havryliv T. Exploring the Effect of Subtotal Resection on Survival Outcome in Glioblastoma: A Case Study. [Regional Clinical Center of Neurosurgery and Neurology, Uzhhorod National University, Ukraine, 2025]
11. Chaulagain D, Smolanka V, Smolanka A, Havryliv T. The Impact of Extent of Resection in Surgical Outcome of Pilomyxoid Astrocytoma: A Case Study. Ukrainian Neurosurgical Journal. 2021;27(4):43-48. doi:10.25305/unj.242926
12. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: A Summary. Neuro Oncol. 2021;23(8):1231-1251. doi:10.1093/neuonc/noab106
13. Ostrom QT, Price M, Neff C, et al. CBTRUS Statistical Report: Primary Brain and Other CNS Tumors Diagnosed in the United States in 2016–2020. Neuro Oncol. 2023;25(Suppl 4):iv1-iv99. doi:10.1093/neuonc/noad149
14. Ostrom QT, Gittleman H, Farah P, et al. CBTRUS Statistical Report: Primary Brain and Other CNS Tumors Diagnosed in the United States in 2017–2021. Neuro Oncol. 2024;26(Suppl 6):vi1-vi55.
15. Brat DJ, Aldape K, Colman H, et al. Grading of Adult Diffuse Gliomas According to the 2021 WHO Classification of Tumors of the Central Nervous System. Laboratory Investigation. 2022;102(2):127-135. doi:10.1038/s41374-021-00681-4
16. Park YW, Ahn SS, Kim EH, et al. Advanced MRI for the Diagnosis and Management of Diffuse Gliomas. Front Oncol. 2023;13:1079965. doi:10.3389/fonc.2023.1079965
17. van den Bent MJ, Afra D, de Witte O, et al. Long-term Efficacy of Early Versus Delayed Radiotherapy for Low-Grade Astrocytoma and Oligodendroglioma in Adults: EORTC 22845 Randomised Trial. Lancet. 2005;366(9490):985-990. doi:10.1016/S0140-6736(05)67070-5
18. Brusniak K, Tomczyk M, Kaczmarek A, et al. Supramaximal versus Gross Total Resection in Glioblastoma IDH-Wildtype and Astrocytoma IDH-Mutant Grade 4: Systematic Review and Meta-Analysis. World Neurosurgery. 2023;179:e46-e55. doi:10.1016/j.wneu.2023.07.124
19. Stummer W, Pichlmeier U, Meinel T, et al. Fluorescence-Guided Surgery with 5-Aminolevulinic Acid for Resection of Malignant Glioma: A Randomised Controlled Multicentre Phase III Trial. Lancet Oncol. 2006;7(5):392-401. doi:10.1016/S1470-2045(06)70665-9
20. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma. N Engl J Med. 2005;352(10):987-996. doi:10.1056/NEJMoa043330
21. van den Bent MJ, Tesileanu CMS, Wick W, et al. Adjuvant and Concurrent Temozolomide for 1p/19q Non-Co-Deleted Anaplastic Glioma (CATNON): Second Interim Analysis. Lancet Oncol. 2021;22(6):813-823. doi:10.1016/S1470-2045(21)00090-5
22. Kim IK, Gittleman H, Ostrom QT, et al. Efficacy of Various Extent of Resection on Survival Rates of Patients with Pilocytic Astrocytoma: Based on a Large Population. Scientific Reports. 2024;14:24812. doi:10.1038/s41598-024-75751-0
23. Stupp R, Taillibert S, Kanner A, et al. Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients with Glioblastoma: EF-14 Trial. JAMA. 2017;318(23):2306-2316. doi:10.1001/jama.2017.18718
24. Mellinghoff IK, van den Bent MJ, Blumenthal DT, et al. Vorasidenib in IDH1- or IDH2-Mutant Low-Grade Glioma (INDIGO Trial). N Engl J Med. 2023;389(7):589-601. doi:10.1056/NEJMoa2304194
25. Weller M, van den Bent M, Preusser M, et al. EANO Guidelines on the Diagnosis and Treatment of Diffuse Gliomas of Adulthood. Nat Rev Clin Oncol. 2021;18(3):170-186. doi:10.1038/s41571-020-00447-z
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