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Journal of Neuro-Oncology

, Volume 95, Issue 2, pp 219–229 | Cite as

Stereotactic radiosurgery for pilocytic astrocytomas part 2: outcomes in pediatric patients

  • Hideyuki Kano
  • Ajay Niranjan
  • Douglas Kondziolka
  • John C. Flickinger
  • Ian F. Pollack
  • Regina I. Jakacki
  • L. Dade Lunsford
Clinical Study - Patient Study

Abstract

To assess outcomes after stereotactic radiosurgery (SRS) for newly diagnosed or recurrent pilocytic astrocytomas in pediatric patients. Fifty patients (28 male and 22 females) with juvenile pilocytic astrocytomas (JPA) underwent Gamma knife SRS between 1987 and 2006. The median patient age was 10.5 years (range, 4.2–17.9 years). Three patients had failed prior fractionated radiation therapy (RT) and two had failed RT and chemotherapy. The median radiosurgery target volume was 2.1 cc (range, 0.17–14.4 cc) and the median margin dose was 14.5 Gy (range, 11–22.5 Gy). At a median follow-up of 55.5 months (range 6.0–190 months), one patient died and 49 were alive. The progression free survival after SRS (including tumor growth and cyst enlargement) for the entire series was 91.7, 82.8 and 70.8% at 1, 3 and 5 years, respectively. Stereotactic radiosurgery for pediatric pilocytic astrocytomas should be considered when resection is not feasible, or if there is an early recurrence. The best response was observed in small volume residual solid tumors.

Keywords

Stereotactic radiosurgery Gamma knife Pilocytic astrocytoma Brain tumor 

Notes

Acknowledgments

The work described in this report was funded by a grant (to H·K.) from the Osaka Medical Research Foundation for Incurable Diseases.

Conflict of interest statement

Drs. Lunsford, Kondziolka, and Niranjan are consultants with AB Elekta. Dr. Lunsford is a stockholder in AB Elekta.

References

  1. 1.
    Bucy PC, Thieman PW (1968) Astrocytomas of the cerebellum. A study of a series of patients operated upon over 28 years ago. Arch Neurol 18:14–19CrossRefPubMedGoogle Scholar
  2. 2.
    Scott RM, Ballantine HT Jr (1973) Cerebellar astrocytoma: malignant recurrence after prolonged postoperative survival. Case report. J Neurosurg 39:777–779CrossRefPubMedGoogle Scholar
  3. 3.
    Burger PC, Scheithauer BW, Paulus W et al (2000) Pathology and genetics of tumours of the nervous system. In: Kleihues P, Cavenee WK et al (eds) World Health Organization classification of tumours. IARC Press, Lyon, pp 45–51Google Scholar
  4. 4.
    Fulham MJ, Melisi JW, Nishimiya J, Dwyer AJ, Di Chiro G (1993) Neuroimaging of juvenile pilocytic astrocytomas: an enigma. Radiology 189:221–225CrossRefPubMedGoogle Scholar
  5. 5.
    Palma L, Russo A, Mercuri S (1983) Cystic cerebral astrocytomas in infancy and childhood: long-term results. Childs Brain 10:79–91PubMedGoogle Scholar
  6. 6.
    Larson DA, Wara WM, Edwards MS (1990) Management of childhood cerebellar astrocytoma. Int J Radiat Oncol Biol Phys 18:971–973 (editorial)CrossRefPubMedGoogle Scholar
  7. 7.
    Burger PC, Breiter SN, Fisher PG (1996) Pilocytic and fibrillary astrocytomas of the brainstem—a comparative clinical, radiological and pathological study. J Neuropathol Exp Neurol 55:640. doi: 10.1097/00005072-199605000-00150 CrossRefGoogle Scholar
  8. 8.
    Rodriguez HA, Edwards MS, Levin VA (1990) Management of hypothalamic gliomas in children: an analysis of 33 cases. Neurosurgery 26:242–246. doi: 10.1097/00006123-199002000-00010 CrossRefPubMedGoogle Scholar
  9. 9.
    Hoyt WF, Baghdassarian SA (1969) Optic glioma of childhood. Natural history and rationale for conservative management. Br J Ophthalmol 53:793–798. doi: 10.1136/bjo.53.12.793 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Packer RJ, Ater J, Allen J et al (1997) Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas. J Neurosurg 86:747–754CrossRefPubMedGoogle Scholar
  11. 11.
    Prados MD, Edwards MS, Rabbitt J et al (1997) Treatment of paediatric low-grade gliomas with a nitrosourea-based multiagent chemotherapy regimen. J Neurooncol 32:235–241. doi: 10.1023/A:1005736104205 CrossRefPubMedGoogle Scholar
  12. 12.
    Boethius J, Ulfarsson E, Rahn T, Lippittz B (2002) Gamma knife radiosurgery for pilocytic astrocytomas. J Neurosurg 97(Suppl 5):677–680PubMedGoogle Scholar
  13. 13.
    Hadjipanayis CG, Kondziolka D, Gardner P, Niranjan A, Dagam S, Flickinger JC et al (2002) Stereotactic radiosurgery for pilocytic astrocytomas when multimodal therapy is necessary. J Neurosurg 97:56–64CrossRefPubMedGoogle Scholar
  14. 14.
    Kondziolka D, Lunsford LD, Flickinger JC (1992) Stereotactic radiosurgery in children and adolescents. Pediatr Neurosurg 16:219–221. doi: 10.1159/000120530 CrossRefGoogle Scholar
  15. 15.
    Somaza SC, Kondziolka D, Lunsford LD, Flickinger JC, Bissonette DJ, Albright AL (1996) Early outcomes after stereotactic radiosurgery for growing pilocytic astrocytomas in children. Pediatr Neurosurg 25:109–115. doi: 10.1159/000121107 CrossRefPubMedGoogle Scholar
  16. 16.
    Garcia DM, Fulling KH (1985) Juvenile pilocytic astrocytoma of the cerebrum in adults. A distinctive neoplasm with favorable prognosis. J Neurosurg 63:382–386CrossRefPubMedGoogle Scholar
  17. 17.
    Geissinger JD (1971) Astrocytomas of the cerebellum in children. Long-term study. Arch Neurol 24:125–135CrossRefPubMedGoogle Scholar
  18. 18.
    Ilgren EB, Stiller CA (1986) Cerebellar astrocytomas: therapeutic management. Acta Neurochir (Wien) 81:11–26. doi: 10.1007/BF01456260 CrossRefGoogle Scholar
  19. 19.
    Kehler U, Arnold H, Muller H (1990) Long-term follow-up of infratentorial pilocytic astrocytomas. Neurosurg Rev 13:315–320. doi: 10.1007/BF00346373 CrossRefPubMedGoogle Scholar
  20. 20.
    Conway PD, Oechler HW, Kun LE, Murray KJ (1991) Importance of histologic condition and treatment of pediatric cerebellar astrocytoma. Cancer 67:2772–2775. doi: 10.1002/1097-0142(19910601)67:11<2772::AID-CNCR2820671110>3.0.CO;2-#CrossRefPubMedGoogle Scholar
  21. 21.
    Forsyth PA, Shaw EG, Scheithauer BW, O’Fallon JR, Layton DD Jr, Katzmann JA (1993) Supratentorial pilocytic astrocytomas. A clinicopathologic, prognostic, and flow cytometric study of 51 patients. Cancer 72:1335–1342. doi: 10.1002/1097-0142(19930815)72:4<1335::AID-CNCR2820720431>3.0.CO;2-E CrossRefPubMedGoogle Scholar
  22. 22.
    Gjerris F, Klinken L (1978) Long term prognosis in children with benign cerebellar astrocytomas. J Neurosurg 49:179–184CrossRefPubMedGoogle Scholar
  23. 23.
    Hayostek CJ, Shaw EG, Scheithauer B, O’Fallon JR, Weiland TL, Schomberg PJ et al (1993) Astrocytomas of the cerebellum. A comparative clinicopathologic study of pilocytic and diffuse astrocytomas. Cancer 72:856–869. doi: 10.1002/1097-0142(19930801)72:3<856::AID-CNCR2820720335>3.0.CO;2-K CrossRefPubMedGoogle Scholar
  24. 24.
    Sgouros S, Fineron PW, Hockley AD (1995) Cerebellar astrocytoma of childhood: long-term follow-up. Childs Nerv Syst 11:89–96. doi: 10.1007/BF00303812 CrossRefPubMedGoogle Scholar
  25. 25.
    Wallner KE, Gonzales MF, Edwards MS, Wara WM, Sheline GE (1988) Treatment results of juvenile pilocytic astrocytoma. J Neurosurg 69:171–176CrossRefPubMedGoogle Scholar
  26. 26.
    Hoffman HJ, Soloniuk DS, Humphreys RP, Drake JM, Becker LE, De Lima BO et al (1993) Management and outcome of low-grade astrocytomas of the midline in children: a retrospective review. Neurosurgery 33:964–971. doi: 10.1097/00006123-199312000-00002 PubMedGoogle Scholar
  27. 27.
    Garcia DM, Marks JE, Lafiti HR, Kliefoth AB (1990) Childhood cerebellar astrocytomas: is there a role for postoperative irradiation? Int J Radiat Oncol Biol Phys 18:815–818CrossRefPubMedGoogle Scholar
  28. 28.
    Kidd EA, Mansur DB, Leonard JR, Michalski JM, Simpson JR, Perry A (2006) The efficacy of radiation therapy in the management of grade I astrocytomas. J Neurooncol 76:55–58. doi: 10.1007/s11060-005-2913-1 CrossRefPubMedGoogle Scholar
  29. 29.
    Bajorunas DR, Ghavimi F, Jereb B, Sonenberg M (1980) Endocrine sequelae of antineoplastic therapy in childhood head and neck malignancies. J Clin Endocrinol Metab 50:329–335CrossRefPubMedGoogle Scholar
  30. 30.
    Constine LS, Woolf PD, Cann D, Mick G, McCormic K, Raubertas RF et al (1993) Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 328:87–94. doi: 10.1056/NEJM199301143280203 CrossRefPubMedGoogle Scholar
  31. 31.
    Duffner PK, Cohen ME, Thomas PR, Lansky SB (1985) The long-term effects cranial irradiation on the central nervous system. Cancer 56:1841–1846. doi: 10.1002/1097-0142(19851001)56:7+<1841::AID-CNCR2820561325>3.0.CO;2-C CrossRefPubMedGoogle Scholar
  32. 32.
    Samaan NA, Vieto R, Schultz PN, Maor M, Meoz RT, Sampiere VA et al (1982) Hypothalamic, pituitary, and thyroid dysfunction after radiotherapy to the head and neck. Int J Radiat Oncol Biol Phys 8:1857–1867CrossRefPubMedGoogle Scholar
  33. 33.
    Arita K, Kurisu K, Sugiyama K, Itoh Y, Hotta T, Sogabe T, Uozumi T (2003) Long-term results of conventional treatment of diencephalic pilocytic astrocytoma in infants. Childs Nerv Syst 19:145–151PubMedGoogle Scholar
  34. 34.
    Bernell WR, Kepes JJ, Seitz EP (1972) Late malignant recurrence of childhood cerebellar astrocytoma. Report of two cases. J Neurosurg 37:470–474CrossRefPubMedGoogle Scholar
  35. 35.
    Budka H (1975) Partially resected and irradiated cerebellar astrocytoma of childhood: malignant evolution after 28 years. Acta Neurochir (Wien) 32:139–146. doi: 10.1007/BF01405911 CrossRefGoogle Scholar
  36. 36.
    Dirks PB, Jay V, Becker LE, Drake JM, Humphreys RP, Hoffman HJ et al (1994) Development of anaplastic changes in low-grade astrocytomas of childhood. Neurosurgery 34:68–78. doi: 10.1097/00006123-199401000-00010 PubMedGoogle Scholar
  37. 37.
    Gururangan S, Fisher MJ, Allen JC, Herndon JEII, Quinn JA, Reardon DA et al (2007) Temozolomide in children with progressive low-grade glioma. Neuro-oncology 9:161–168. doi: 10.1215/15228517-2006-030 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Lefay-Cousin L, Holm S, Gaddoumi I et al (2005) Weekly vinblastine in pediatric low-grade glioma patients with carboplatin allergic reaction. Cancer 103:2636–2642. doi: 10.1002/cncr.21091 CrossRefGoogle Scholar
  39. 39.
    Kobayashi T, Kida Y, Hasegawa T (2003) Long-term results of gamma knife surgery for craniopharyngioma. Neurosurg Focus 15:e13Google Scholar
  40. 40.
    Tomlinson FH, Scheithauer BW, Hayostek CJ, Parisi JE, Meyer FB, Shaw EG, Weiland TL, Katzmann JA, Jack CR Jr (1994) The significance of atypia and histologic malignancy in pilocytic astrocytoma of the cerebellum: a clinicopathologic and flow cytometric study. J Child Neurol 9:301–310. doi: 10.1177/088307389400900317 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Hideyuki Kano
    • 1
  • Ajay Niranjan
    • 1
  • Douglas Kondziolka
    • 1
    • 2
  • John C. Flickinger
    • 2
  • Ian F. Pollack
    • 1
  • Regina I. Jakacki
    • 3
  • L. Dade Lunsford
    • 1
    • 2
  1. 1.Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of Radiation OncologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Division of Pediatric Hematology/OncologyChildren’s Hospital of PittsburghPittsburghUSA

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