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Düzkalir AH, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Martínez Moreno N, Martínez Álvarez R, Mathieu D, Niranjan A, Lunsford LD, Wei Z, Shanahan RM, Liscak R, May J, Dono A, Blanco AI, Esquenazi Y, Dayawansa S, Sheehan J, Tripathi M, Shepard MJ, Wegner RE, Upadhyay R, Palmer JD, Peker S. Pleomorphic Xanthoastrocytoma: Multi-Institutional Evaluation of Stereotactic Radiosurgery. Neurosurgery 2025; 96:416-425. [PMID: 38940575 DOI: 10.1227/neu.0000000000003083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial tumor primarily affecting young individuals. Surgery is the primary treatment option; however, managing residual/recurrent tumors remains uncertain. This international multi-institutional study retrospectively assessed the use of stereotactic radiosurgery (SRS) for PXA. METHODS A total of 36 PXA patients (53 tumors) treated at 11 institutions between 1996 and 2023 were analyzed. Data included demographics, clinical variables, SRS parameters, tumor control, and clinical outcomes. Kaplan-Meier estimates summarized the local control (LC), progression-free survival, and overall survival (OS). Secondary end points addressed adverse radiation effects and the risk of malignant transformation. Cox regression analysis was used. RESULTS A total of 38 tumors were grade 2, and 15 tumors were grade 3. Nine patients underwent initial gross total resection, and 10 received adjuvant therapy. The main reason for SRS was residual tumors (41.5%). The median follow-up was 34 months (range, 2-324 months). LC was achieved in 77.4% of tumors, with 6-month, 1-year, and 2-year LC estimates at 86.7%, 82.3%, and 77.8%, respectively. Younger age at SRS (hazard ratios [HR] 3.164), absence of peritumoral edema (HR 4.685), and higher marginal dose (HR 6.190) were significantly associated with better LC. OS estimates at 1, 2, and 5 years were 86%, 74%, and 49.3%, respectively, with a median OS of 44 months. Four patients died due to disease progression. Radiological adverse radiation effects included edema (n = 8) and hemorrhagic change (n = 1). One grade 3 PXA transformed into glioblastoma 13 months after SRS. CONCLUSION SRS offers promising outcomes for PXA management, providing effective LC, reasonable progression-free survival, and minimal adverse events.
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Affiliation(s)
- Ali Haluk Düzkalir
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
- Department of Neurosurgery, Gamma Knife Center, Koc University Hospital, Istanbul , Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Benha University, Benha , Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Clinical Oncology, Ain Shams University, Cairo , Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Neurosurgery, Ain Shams University, Cairo , Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo , Egypt
| | | | | | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke , Quebec , Canada
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Regan M Shanahan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston , Texas , USA
| | - Angel I Blanco
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston , Texas , USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston , Texas , USA
| | - Samantha Dayawansa
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network Cancer Institute, Pittsburgh , Pennsylvania , USA
| | - Rodney E Wegner
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh , Pennsylvania , USA
| | - Rituraj Upadhyay
- Department of Radiation Oncology, The James Cancer Center, Ohio State University, Columbus , Ohio , USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Center, Ohio State University, Columbus , Ohio , USA
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
- Department of Neurosurgery, Gamma Knife Center, Koc University Hospital, Istanbul , Turkey
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Liang Q, Wu Z, Zhu S, Du Y, Cheng Z, Chen Y, Lin F, Wang J. A bibliometric analysis of research trends and hotspots of pilocytic astrocytoma from 2004 to 2023. Neurosurg Rev 2024; 48:3. [PMID: 39724457 DOI: 10.1007/s10143-024-03139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 11/02/2024] [Accepted: 11/30/2024] [Indexed: 12/28/2024]
Abstract
Pilocytic astrocytoma (PA) is a WHO grade I neoplasm with a favorable prognosis. It is the most common pediatric benign tumor. Recently, PA has attracted more and more attention and discussion from scholars. The aim of this study is to comprehensively generalize the evolution of this field over the past two decades through bibliometric analysis and to predict future research trends and hotspots. The literature over the last two decades (2004-2023) related to PA was obtained from the Web of Science Core Collection (WoSCC) database. Bibliometric analyses were conducted based on the following aspects: (1) Annual publication trends; (2) Publications, citations/co-citations of different countries/institutions/journals/authors; (3) the map of Bradford's Law and Lotka's Law for core journals and author productivity; (4) Co-occurrence, cluster, thematic map analysis of keywords. All analyses were performed on VOSviewer and R bibliometrix package, and Excel 2024. Our results showed that research on PA displayed a considerable development trend in the past 20 years. The USA had a leading position in terms of scientific outputs and collaborations. Meanwhile, German Cancer Research Center contributed the most publications. Child's Nervous System had the highest number of publications and Acta Neuropathologica was the most co-cited journal on this subject. Gutmann, D.H. and Louis, D.N. were the authors with the most articles and co-citations in this field. The research emphases were molecular mechanisms, neurofibromatosis, pilomyxoid astrocytoma, differential diagnosis, and therapy. We systematically analyzed the literature on PA from a bibliometric perspective. The demonstrated results of the knowledge mapping would provide valuable insights into the global research landscape.
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Affiliation(s)
- Qingtian Liang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zuqing Wu
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Sihan Zhu
- University Hospital Ludwig Maximilian University Munich, 81377, Munich, Germany
| | - Yizhi Du
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhuqing Cheng
- University Hospital Ludwig Maximilian University Munich, 81377, Munich, Germany
| | - Yinsheng Chen
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Fuhua Lin
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Jian Wang
- Department of Neurosurgery and Neuro-Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
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3
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Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Gumustepe E, Ozcan F, Colak O, Gursoy AT, Dursun CU, Tugcu AO, Dogru GD, Arslan R, Elcim Y, Gundem E, Dirican B, Beyzadeoglu M. Concise review of radiosurgery for contemporary management of pilocytic astrocytomas in children and adults. World J Exp Med 2022; 12:36-43. [PMID: 35765513 PMCID: PMC9168785 DOI: 10.5493/wjem.v12.i3.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/09/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Pilocytic astrocytoma (PA) may be seen in both adults and children as a distinct histologic and biologic subset of low-grade glioma. Surgery is the principal treatment for the management of PAs; however, selected patients may benefit from irradiation particularly in the setting of inoperability, incomplete resection, or recurrent disease. While conventionally fractionated radiation therapy has been traditionally utilized for radiotherapeutic management, stereotactic irradiation strategies have been introduced more recently to improve the toxicity profile of radiation delivery without compromising tumor control. PAs may be suitable for radiosurgical management due to their typical appearance as well circumscribed lesions. Focused and precise targeting of these well-defined lesions under stereotactic immobilization and image guidance may offer great potential for achieving an improved therapeutic ratio by virtue of radiosurgical techniques. Given the high conformality along with steep dose gradients around the target volume allowing for reduced normal tissue exposure, radiosurgery may be considered a viable modality of radiotherapeutic management. Another advantage of radiosurgery may be the completion of therapy in a usually shorter overall treatment time, which may be particularly well suited for children with requirement of anesthesia during irradiation. Several studies have addressed the utility of radiosurgery particularly as an adjuvant or salvage treatment modality for PA. Nevertheless, despite the growing body of evidence supporting the use of radiosurgery, there is need for a high level of evidence to dictate treatment decisions and establish its optimal role in the management of PA. Herein, we provide a concise review of radiosurgery for PA in light of the literature.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Esra Gumustepe
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Fatih Ozcan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Onurhan Colak
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Ahmet Tarik Gursoy
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Cemal Ugur Dursun
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Ahmet Oguz Tugcu
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Galip Dogukan Dogru
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Rukiyye Arslan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Esin Gundem
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
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Khan K, Luther E, Morrell AA, Tan SK, Eichberg DG, Shah AH, Lu VM, Gultekin SH, Morcos JJ. Recurrent adult pilocytic astrocytoma presenting with intraventricular and leptomeningeal spread. Surg Neurol Int 2021; 12:359. [PMID: 34345499 PMCID: PMC8326142 DOI: 10.25259/sni_423_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background Infratentorial pilocytic astrocytomas are uncommon tumors in adulthood but are thought to be prognostically similar to their pediatric counterparts with excellent overall survival following gross total resection. However, given the relative rarity of these tumors, no management guidelines exist for recurrent adult pilocytic astrocytomas (APAs). This lack of consensus is especially problematic for inoperable recurrences or those with aggressive features concerning for malignant transformation. Case Description In 2017, a 26-year-old female presented with headaches, nausea, vomiting, and blurry vision. A brain magnetic resonance imaging (MRI) demonstrated a large, well-circumscribed mass within the fourth ventricle causing obstructive hydrocephalus. She underwent near-total resection through a midline suboccipital transtonsillar approach. Pathology demonstrated a World Health Organization Grade 1 pilocytic astrocytoma. Despite initial improvement in her symptoms, she developed worsening headaches and lethargy 10 months after surgery and repeat MRI demonstrated recurrent tumor within the entire ventricular system and the subarachnoid spaces of the left cerebellopontine angle suggesting leptomeningeal spread. Due to the unresectable nature of the recurrence, the patient declined any further intervention and succumbed to her disease 6 months later. Conclusion We present the first case of a recurrent APA presenting with intraventricular and leptomeningeal spread. Although thought to be a benign neoplasm, close interval follow-up with serial imaging is of essential, especially in those patients with known residual tumor, to prevent aggressive recurrences such as this.
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Affiliation(s)
- Khadeja Khan
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Evan Luther
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alexis A Morrell
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Sze Kiat Tan
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Daniel G Eichberg
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ashish H Shah
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Victor M Lu
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Sakir H Gultekin
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jacques J Morcos
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
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5
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Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Colak O, Ozcan F, Gundem E, Elcim Y, Dirican B, Beyzadeoglu M. Concise review of stereotactic irradiation for pediatric glial neoplasms: Current concepts and future directions. World J Methodol 2021; 11:61-74. [PMID: 34026579 PMCID: PMC8127424 DOI: 10.5662/wjm.v11.i3.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Brain tumors, which are among the most common solid tumors in childhood, remain a leading cause of cancer-related mortality in pediatric population. Gliomas, which may be broadly categorized as low grade glioma and high grade glioma, account for the majority of brain tumors in children. Expectant management, surgery, radiation therapy (RT), chemotherapy, targeted therapy or combinations of these modalities may be used for management of pediatric gliomas. Several patient, tumor and treatment-related characteristics including age, lesion size, grade, location, phenotypic and genotypic features, symptomatology, predicted outcomes and toxicity profile of available therapeutic options should be considered in decision making for optimal treatment. Management of pediatric gliomas poses a formidable challenge to the physicians due to concerns about treatment induced toxicity. Adverse effects of therapy may include neurological deficits, hemiparesis, dysphagia, ataxia, spasticity, endocrine sequelae, neurocognitive and communication impairment, deterioration in quality of life, adverse socioeconomic consequences, and secondary cancers. Nevertheless, improved understanding of molecular pathology and technological advancements may pave the way for progress in management of pediatric glial neoplasms. Multidisciplinary management with close collaboration of disciplines including pediatric oncology, surgery, and radiation oncology is warranted to achieve optimal therapeutic outcomes. In the context of RT, stereotactic irradiation is a viable treatment modality for several central nervous system disorders and brain tumors. Considering the importance of minimizing adverse effects of irradiation, radiosurgery has attracted great attention for clinical applications in both adults and children. Radiosurgical applications offer great potential for improving the toxicity profile of radiation delivery by focused and precise targeting of well-defined tumors under stereotactic immobilization and image guidance. Herein, we provide a concise review of stereotactic irradiation for pediatric glial neoplasms in light of the literature.
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Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Ferrat Dincoglan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Selcuk Demiral
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Bora Uysal
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Hakan Gamsiz
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Onurhan Colak
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Fatih Ozcan
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Esin Gundem
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Yelda Elcim
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Bahar Dirican
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
| | - Murat Beyzadeoglu
- Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
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Qie S, Yuan L, Shi HY, Zhang X, Li Y. Conventionally fractionated stereotactic radiotherapy (CFRT) in combination with dose-dense temozolomide (TMZ) in relapsed malignant glioma: A case report. Medicine (Baltimore) 2019; 98:e13869. [PMID: 30608405 PMCID: PMC6344191 DOI: 10.1097/md.0000000000013869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE At present, there is no uniform consensus on the treatment of recurrent glioblastoma, especially the re-irradiation dose and temozolomide (TMZ) dose. The literature on the treatment of recurrent glioblastoma (GBM) by conventionally fractionated stereotactic radiotherapy (CFRT) is even rarer. PATIENT CONCERNS A 44-year-old woman was admitted to our hospital for residual tumor after reoperation. DIAGNOSES Postoperative pathological diagnosis was GBM, WHO grade IV. The brain magnetic resonance imaging re-examination showed abnormal enhancement around the local operative region after resection of the left frontal lobe tumor, and there was presence of residual tumor. INTERVENTIONS The patient was treated with reoperation followed by re-irradiation plus dose-dense TMZ to achieve complete remission. OUTCOMES Complete remission was observed at the end of radiotherapy and at the 1 month follow-up after radiotherapy. LESSONS This study suggests that CFRT plus dose-dense TMZ might be a feasible option for the treatment in relapsed malignant glioma patients with good general condition.
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7
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Management and Survival of Adult Patients with Pilocytic Astrocytoma in the National Cancer Database. World Neurosurg 2018; 112:e881-e887. [PMID: 29427814 DOI: 10.1016/j.wneu.2018.01.208] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adult pilocytic astrocytomas (PAs) are relatively rare central nervous system (CNS) tumors with a favorable prognosis. We sought to investigate existing clinical management strategies and overall survival (OS) as a function of various clinical characteristics in a cohort of adult patients with PA. METHODS The study cohort comprised all patients age >18 years diagnosed with a CNS PA diagnosed between 2004 and 2014 and included in the National Cancer Database. Clinical and treatment-related characteristics were recorded and analyzed for associations with OS following diagnosis using univariate and multivariate analyses. RESULTS A total of 3057 adult patients, with a median age of 32 years, met the inclusion criteria. At diagnosis, 1138 patients (41%) had cerebral tumors, 832 (30%) had cerebellar tumors, 252 (9%) had tumors of the spinal cord, and 534 (19%) had tumors of unspecified location. More than three-quarters (77%) of the patients underwent surgery alone as local therapy, with the remainder split among surgery plus radiation (11.9%), radiation alone (4.5%), and biopsy alone (6.9%). On multivariate analysis, factors associated with inferior OS included older age (hazard ratio [HR], 1.05; P < 0.001), lower income (P < 0.001), higher Charlson/Deyo score (P = 0.023), larger tumor size (P = 0.023), and radiation therapy technique (P < 0.001; HR, 3.37 for external beam radiation therapy [EBRT]). CONCLUSIONS Our data provide large-scale prognostic information from a contemporary cohort of patients with PA, confirming that age, median income, Charlson/Deyo Score, and tumor size have significant effects on OS. Although resection status, tumor size, and location likely bias against EBRT, novel therapeutics are clearly needed in patients with tumors not amenable to resection or radiosurgery.
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MANEJO DE LOS TUMORES CEREBRALES ASTROCÍTICOS Y OLIGODENDROGLIALES. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Harat M, Lebioda A, Lasota J, Makarewicz R. Evaluation of Brain Edema Formation Defined By MRI After LINAC-based Stereotactic Radiosurgery. Radiol Oncol 2017; 51:137-141. [PMID: 28740448 PMCID: PMC5514653 DOI: 10.1515/raon-2017-0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 03/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background Peri-lesional edema is a serious and well-known complication of stereotactic radiosurgery (SRS). Here we evaluated edema risk after SRS and assessed its formation and resolution dynamics. Patients and methods 107 patients underwent SRS for heterogeneous diagnoses: 34 (29%) with arteriovenous malformations, 38 (35%) with meningiomas, 16 (15%) with metastatic tumors, 16 (15%) with acoustic neuromas, 3 with (3%) cavernomas, and 2 (2%) each with anaplastic astrocytomas and anaplastic oligoastrocytomas. Edema area was delineated in MRI T2-FLAIR sequences 0, 6, 12, 18, 24, 30, and 38 months after treatment. Lesion location was defined as either above (n = 80) or below (n = 32) the “Frankfurt modified line” (FML). Results 17% of patients developed or had worsening post-treatment edema. Edema volume was maximal at 6 months (mean 7.2, SD 1.2) post radiosurgery. Post-SRS edema was 5.1 (1.06 – 24.53) times more likely in patients with lesions above the FML. There was no association between edema development and age, PTV size, number of beams, and diagnosis (p = 0.07). Conclusions Radiosurgery-associated edema develops within 6 months of treatment and decreases over time. Edema occurrence is strongly related to lesion location, and its presence is much more likely when the treated lesions are situated above the Frankfurt line.
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Affiliation(s)
- Maciej Harat
- Department of Radiotherapy, The Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
| | - Andrzej Lebioda
- Department of Oncology and Brachytherapy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland.,Department of Oncology and Brachytherapy, The Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
| | - Judyta Lasota
- Department of Medical Physics, The Franciszek Lukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Roman Makarewicz
- Department of Oncology and Brachytherapy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland.,Department of Oncology and Brachytherapy, The Franciszek Lukaszczyk Oncology Center, Bydgoszcz, Poland
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Gagliardi F, Bailo M, Spina A, Donofrio CA, Boari N, Franzin A, Fava A, Del Vecchio A, Bolognesi A, Mortini P. Gamma Knife Radiosurgery for Low-Grade Gliomas: Clinical Results at Long-Term Follow-Up of Tumor Control and Patients' Quality of Life. World Neurosurg 2017; 101:540-553. [PMID: 28216397 DOI: 10.1016/j.wneu.2017.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE First-line therapy for low-grade gliomas (LGGs) is surgery, in some cases followed by radiotherapy and chemotherapy. Gamma Knife radiosurgery (GKRS) has gained more relevance in the management of these tumors. The aim of this study was to assess efficacy and safety of GKRS for treatment of LGGs. METHODS Between 2001 and 2014, 42 treatments were performed on 39 patients harboring LGGs; 48% of patients underwent previous surgery, and 20.5% underwent previous radiotherapy. Mean tumor volume was 2.7 cm3, and median margin dose was 15 Gy. RESULTS Mean follow-up was 60.5 months (range, 6-164 months). Actuarial progression-free survival was 74.9%, 52.8%, and 39.1% at 1 year, 5 years, and 10 years; actuarial overall survival was 97.4%, 94.6%, and 91.8% at 9 months, 1 year, and 5 years. Solid tumor control was achieved in 69.2% of patients, whereas cystic enlargement was recorded in 12.9% of cases. At last follow-up, volume reduction was recorded in 57.7% of cases, and median volume decreased by 33.3%. Clinical improvement was observed in 52.4% of patients. Karnofsky performance scale score was improved in 15 patients (45.5%), unchanged in 17 patients (51.5%), and worsened in 1 patient (3%). Mean posttreatment scores of 36-item short form health survey domains did not significantly differ from scores in a healthy Italian population. CONCLUSIONS This study confirms safety and effectiveness of GKRS for LGGs in controlling tumor growth, relevantly improving patients' overall and progression-free survival. GKRS improved patients' functional performance and quality of life, optimizing social functioning and minimizing disease-related psychological impact.
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Affiliation(s)
- Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Carmine A Donofrio
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alberto Franzin
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Arianna Fava
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonella Del Vecchio
- Service of Medical Physics, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Angelo Bolognesi
- Service of Radiation Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Tuleasca C, Negretti L, Magaddino V, Maeder P, Lhermitte B, Borruat FX, Levivier M. Biphasic response of a tecto-mesencephalic pilocytic astrocytoma after Gamma Knife surgery--A case report. Neurochirurgie 2015; 61:275-8. [PMID: 26072229 DOI: 10.1016/j.neuchi.2014.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/18/2014] [Accepted: 11/29/2014] [Indexed: 11/20/2022]
Abstract
Biphasic response (shrinkage-regrowth-shrinkage) of tumors has never previously been reported in the postoperative course, neither after microsurgery, nor after Gamma Knife surgery (GKS). We present the case of an adult with dorsal midbrain syndrome resulting from a pilocytic astrocytoma centered on the mesencephalic tectum. The tumor extended to the third ventricle and the thalamus. Initially, due to tumor growth, a biopsy was performed and histology established. Later, a ventriculocisternostomy for obstructive hydrocephalus was performed. Finally, GKS was performed, as the tumor continued to grow. After GKS, the lesion exhibited a biphasic response, with a major shrinkage at 3 months, regrowth within the target volume at 6 and 9 months and a second phase of important shrinkage at 12 months, which persisted for the next two years. The possible mechanisms for this particular response pattern are discussed.
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Affiliation(s)
- C Tuleasca
- Neurosurgery service, Gamma Knife center, CHU Vaudois, Lausanne, Switzerland; Medical image analysis laboratory (MIAL), CHU Vaudois, Lausanne, Switzerland; École politechnique fédérale de Lausanne, signal processing laboratory (LTS 5), Lausanne, Switzerland; Faculty of biology and medicine, university of Lausanne, Lausanne, Switzerland.
| | - L Negretti
- Radiation oncology service, CHU Vaudois, Lausanne, Switzerland; Radiation oncology department, Clinica Luganese, Lugano, Switzerland
| | - V Magaddino
- Institute of radiation physics, CHU Vaudois, Lausanne, Switzerland; Faculty of biology and medicine, university of Lausanne, Lausanne, Switzerland
| | - P Maeder
- Radiology department, CHU Vaudois, Lausanne, Switzerland; Faculty of biology and medicine, university of Lausanne, Lausanne, Switzerland
| | - B Lhermitte
- Neuropathology department, CHU Vaudois, Lausanne, Switzerland; Faculty of biology and medicine, university of Lausanne, Lausanne, Switzerland
| | - F-X Borruat
- Unité de neuro-ophtalmologie, service universitaire d'ophtalmologie, hôpital ophtalmique Jules-Gonin, Lausanne, Switzerland; Faculty of biology and medicine, university of Lausanne, Lausanne, Switzerland
| | - M Levivier
- Neurosurgery service, Gamma Knife center, CHU Vaudois, Lausanne, Switzerland; Faculty of biology and medicine, university of Lausanne, Lausanne, Switzerland
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Abstract
The use of radiotherapy in low-grade glioma has been a topic of controversy over the past 2 decades. Although earlier studies showed no overall survival benefit and no dose response, recent studies demonstrate a possible synergism between radiotherapy and chemotherapy. However, many questions remained unanswered regarding the proper management including the potential roles of biological imaging in treatment planning, the role of reirradiation after recurrence, the role of intensity-modulated radiation therapy and proton beam radiotherapy, and the proper choice of chemotherapy agents. Further clinical trials are necessary to help integrate these new therapies and technologies into clinical practice.
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Cerebellar pilocytic astrocytoma in adults: a management paradigm for a rare tumour. Acta Neurochir (Wien) 2013; 155:1431-5. [PMID: 23793962 DOI: 10.1007/s00701-013-1790-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pilocytic astrocytoma is one of the commonest subtypes of glioma to affect children. However, they are rarely diagnosed in patients over the age of 18 years. In adults, these tumours appear more frequently supra-tentorially than in the cerebellum and some reports suggest a different clinical course in adults. We reviewed ten patients aged 18 or over who had been operated on for cerebellar pilocytic astrocytoma to assess the impact of tumour biology and extent of resection on outcome in adults. METHOD Patients were identified from a neuropathology database and a retrospective chart review of ten patients was performed. Recorded data included patient demographics, tumour location, presenting features, radiological appearance, extent of surgical resection, tumour recurrence and Ki-67 proliferation index. RESULTS Nine patients were men and one patient was a woman. Median follow up is 41.5 months (range 15-334 months). Complete surgical resection was achieved in nine of the patients operated in our institution. One patient had prior subtotal resection elsewhere. Tumour recurrence was seen only in the two patients with subtotal resection, at 7 and 25 years. Ki-67 ranged from <1 to 10% and appears to have no correlation to recurrence. No patients in this series had adjuvant treatment. CONCLUSIONS Cerebellar pilocytic astrocytomas in adults should be treated with macroscopic complete surgical resection whenever possible. If this is achieved, long-term survival rates are excellent, whereas subtotal resection carries a high risk of tumour recurrence. Ki-67 is less important prognostically than the extent of initial resection.
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Weintraub D, Yen CP, Xu Z, Savage J, Williams B, Sheehan J. Gamma knife surgery of pediatric gliomas. J Neurosurg Pediatr 2012; 10:471-7. [PMID: 23061823 DOI: 10.3171/2012.9.peds12257] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT While some low-grade pediatric gliomas may be cured with resection, many patients harbor tumors that cannot be completely resected safely, are difficult to access via an open surgical approach, or recur. Gamma Knife surgery may be beneficial in the treatment of these tumors. METHODS The authors reviewed a consecutive series of 24 pediatric patients treated at the authors' institution between 1989 and 2011. All patients harbored tumors that were either surgically inaccessible or had evidence of residual or recurrent growth after resection. Progression-free survival was evaluated and correlated with clinical variables. Additional outcomes evaluated were clinical outcome, imaging response, and overall survival. RESULTS Between 1989 and 2011, 13 male and 11 female patients (median age 11 years, range 4-18 years) with gliomas were treated. Tumor pathology was pilocytic astrocytoma (WHO Grade I) in 15 patients (63%), WHO Grade II in 4 (17%), and WHO Grade III in 1 (4%). The tumor pathology was not confirmed in 4 patients (17%). The mean tumor volume at the time of treatment was 2.4 cm(3). Lesions were treated with a median maximum dose of 36 Gy, median of 3 isocenters, and median marginal dose of 15 Gy. The median duration of imaging follow-up was 74 months, and the median duration of clinical follow-up was 144 months. The tumors responded with a median decrease in volume of 71%. At last follow up, a decrease in tumor size of at least 50% was demonstrated in 18 patients (75%) and complete tumor resolution was achieved in 5 (21%). Progression-free survival at last follow-up was achieved in 20 patients (83%). Progression was documented in 4 patients (17%), with 3 patients requiring repeat resection and 1 patient dying. The initial tumor volume was significantly greater in patients with disease progression (mean volume 4.25 vs 2.0 cm(3), p < 0.001). Age, tumor pathology, tumor location, previous radiation, Karnofsky Performance Scale score, symptom duration, and target dosage did not differ significantly between the 2 groups. CONCLUSIONS Gamma Knife surgery can provide good clinical control of residual or recurrent gliomas in pediatric patients. Worse outcomes in the present series were associated with larger tumor volumes at the time of treatment.
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Affiliation(s)
- David Weintraub
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA
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