Advertisement

Journal of Neuro-Oncology

, Volume 95, Issue 2, pp 211–218 | Cite as

Stereotactic radiosurgery for pilocytic astrocytomas part 1: outcomes in adult patients

  • Hideyuki Kano
  • Douglas Kondziolka
  • Ajay Niranjan
  • John C. Flickinger
  • L. Dade Lunsford
Clinical Study - Patient Study

Abstract

To assess outcomes when stereotactic radiosurgery (SRS) is used during multimodality management of pilocytic astrocytomas in adult patients. Fourteen patients (six male and eight females) with pilocytic astrocytomas underwent SRS between 1994 and 2006. The median patient age was 32 years (range, 19–52 years). Initial surgical management included stereotactic biopsy (N = 4), gross total resection (N = 1), and partial resection (N = 9). Fractionated radiation therapy had failed in six patients. The median radiosurgery target volume was 4.7 cc (range, 0.6–33.7 cc) and the median margin dose was 13.3 Gy (range, 10–20 Gy). At a median follow-up of 36.3 months (range 6.1–109 months), three patients died and 11 were alive. The overall survival after SRS for the entire series was 100%, 88.9% and 88.9% at 1, 3 and 5 years, respectively. Localized solid tumor progression was seen in two patients. Cyst progression was noted in three of nine patients with cystic tumors and mixed solid and cyst progression was noted in two with cystic tumors. The progression free survival after SRS (including tumor growth and cyst enlargement) for the entire series was 83.9%, 31.5% and 31.5% at 1, 3 and 5 years, respectively. Prior surgical resection was associated with better progression free survival after SRS (P = 0.027). Despite their purported benign nature, pilocytic astrocytomas in adult patients often do not behave benignly. Unresectable pilocytic astrocytomas that are located in critical or deep areas of the brain require additional management approaches. In this preliminary experience obtained over a 12 year interval, SRS is most valuable for patients after maximal feasible surgical resection. Delayed cyst progression contributes to late loss of tumor control.

Keywords

Stereotactic radiosurgery Gamma knife Pilocytic astrocytoma Adult Brain tumor 

Notes

Acknowledgment

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 A B Elekta. Dr. Lunsford is a stockholder in AB Elekta.

References

  1. 1.
    Bucy PC, Thieman PW (1968) Astrocytomsa 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 (1973) Cerebellar astrocytoma: malignant recurrence after prolonged post operative survival. Case report. J Neurosurg 39:777–779CrossRefPubMedGoogle Scholar
  3. 3.
    Afra D, Muller W, Slowik F, Firsching R (1986) Supratentorial lobar pilocytic astrocytomas: report of 45 operated cases, including 9 recurrences. Acta Neurochir (Wien) 81:90–93. doi: 10.1007/BF01401227 CrossRefGoogle Scholar
  4. 4.
    Bell D, Chitnavis BP, Al-Sarraj S, Connor S, Sharr MM, Gullan RW (2004) Pilocytic astrocytoma of the adult-clinical features, radiological features and management. Br J Neurosurg 18:613–616. doi: 10.1080/02688690400022896 CrossRefPubMedGoogle Scholar
  5. 5.
    Brown PD, Buckner JC, O’Fallon JR et al (2004) Adult patients with supratentorial pilocytic astrocytomas: a prospective multicenter clinical trial. Int J Radiat Oncol Biol Phys 58:1153–1160. doi: 10.1016/j.ijrobp.2003.09.020 CrossRefPubMedGoogle Scholar
  6. 6.
    Fulham MJ, Melisi JW, Nishimiya J et al (1993) Neuroimaging of juvenile pilocytic astrocytomas: an enigma. Radiology 189:221–225CrossRefPubMedGoogle Scholar
  7. 7.
    Palma L, Russo A, Mercuri S et al (1983) Cystic cerebral astrocytomas in infancy and childhood: long-term results. Childs Brain 10:79–91PubMedGoogle Scholar
  8. 8.
    Larson DA, Wara WM, Edwards MS (1990) Management of childhood cerebellar astrocytoma. Int J Radiat Oncol Biol Phys 18:971–973 editorialCrossRefPubMedGoogle Scholar
  9. 9.
    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
  10. 10.
    Khatib Z, Heidemann R, Kovnar E (1992) Pilocytic dorsally exophytic brainstem gliomas: a distinct clinicopathological entity. Ann Neurol 32:458–459Google Scholar
  11. 11.
    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
  12. 12.
    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
  13. 13.
    Boethius J, Ulfarsson E, Rahn T et al (2002) Gamma knife radiosurgery for pilocytic astrocytomas. J Neurosurg 97(Suppl 5):677–680PubMedGoogle Scholar
  14. 14.
    Duffner PK, Cohen ME, Thomas PR et al (1985) The long-term effects cranial irradiation on the central nervous system. Cancer 56:1841–1847. doi: 10.1002/1097-0142(19851001)56:7+<1841::AID-CNCR2820561325>3.0.CO;2-C CrossRefPubMedGoogle Scholar
  15. 15.
    Hadjipanayis CG, Kondziolka D, Gardner P et al (2002) Stereotactic radiosurgery for pilocytic astrocytomas when multimodal therapy is necessary. J Neurosurg 97:56–64CrossRefPubMedGoogle Scholar
  16. 16.
    Kondziolka D, Lunsford LD, Flickinger JC (1992) Stereotactic radiosurgery in children and adolescents. Pediatr Neurosurg 16:219–221. doi: 10.1159/000120530 CrossRefGoogle Scholar
  17. 17.
    Somaza SC, Kondziolka D, Lunsford LD et al (1996) Early outcomes after stereotactic radiosurgery for growing pilocytic astrocytomas in children. Pediatr Neurosurg 25:109–115. doi: 10.1159/000121107 CrossRefPubMedGoogle Scholar
  18. 18.
    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
  19. 19.
    Geissinger JD (1971) Astrocytomas of the cerebellum in children. Long-term study. Arch Neurol 24:125–135CrossRefPubMedGoogle Scholar
  20. 20.
    Ilgren EB, Stiller CA (1986) Cerebellar astrocytomas: therapeutic management. Acta Neurochir (Wien) 81:11–26. doi: 10.1007/BF01456260 CrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    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
  23. 23.
    Stüer C, Vilz B, Majores M, Becker A, Schramm J, Simon M (2007) Frequent recurrence and progression in pilocytic astrocytoma in adults. Cancer 110:2799–2808. doi: 10.1002/cncr.23148 CrossRefPubMedGoogle Scholar
  24. 24.
    Burkhard C, Di Patre PL, Schuler D et al (2003) A populationbased study of the incidence and survival rates in patients with pilocytic astrocytoma. J Neurosurg 98:1170–1174CrossRefPubMedGoogle Scholar
  25. 25.
    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
  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.
    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
  29. 29.
    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
  30. 30.
    Gururangan S, Fisher MJ, Allen JC, Herndon JEII, Quinn JA, Reardon DA et al (2007) Temozolomide in children with progressive low-grade glioma. Neuro-oncol 9:161–168. doi: 10.1215/15228517-2006-030 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Hideyuki Kano
    • 1
  • Douglas Kondziolka
    • 1
    • 2
  • Ajay Niranjan
    • 1
  • John C. Flickinger
    • 1
    • 2
  • 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

Personalised recommendations