Advertisement

Journal of Neuro-Oncology

, Volume 110, Issue 1, pp 99–104 | Cite as

Patterns of care and outcomes of patients with pleomorphic xanthoastrocytoma: a SEER analysis

  • Stephanie M. PerkinsEmail author
  • Nandita Mitra
  • Wan Fei
  • Eric T. Shinohara
Clinical Study

Abstract

To study the clinical characteristics, treatment approach and outcome of pleomorphic xanthoastrocytoma (PXA), patients were identified using the National Cancer Intitute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 214 patients were identified with PXA using the November 2010 submission. Patient demographics, tumor characteristics, extent of surgical resection, the use of radiotherapy, and overall survival were evaluated. Overall survival for PXA was then compared to that of pilocytic astrocytoma, oligodendroglioma, ependymom and glioblastoma also using the SEER database. Kaplan–Meier, univariate and multivariate analyses were performed. The majority of patients were found to be young adults with the most common tumor location being temporal lobe. Surgery was performed on most (95 %) patients, while 25 % of patients received radiation therapy. Five and 10 year overall survival rates were 75 and 67 %, respectively. Grade was only available for a limited number of patients but appeared to affect prognosis. Patients with grade IV tumors had a median overall survival of 45 months, whereas median survival was not reached for grade I–III patients. On multivariate analysis, male gender and increasing age were associated with worse overall survival (p values 0.05 and <0.006, respectively). Extent of resection trended towards significance in favor of gross total resection. PXA is a rare diagnosis that affects young adults. Surgical resection is the primary modality of treatment with an overall good prognosis. Elderly patients, those with higher grade disease and patients with incomplete resections may have a worse prognosis. The role of radiation therapy for PXA remains unclear but is more often used for patients with high grade tumors. Compared to other common brain tumors, PXA’s appear to fare worse than pilocytic astrocytoma and oligodendroglioma, especially in younger patients. However, even high grade PXA patients have significantly better overall survival compared to glioblastoma.

Keywords

Pleomorphic xanthoastrocytoma SEER Surgery Radiation 

Notes

Acknowledgments

The authors would like to thank Dr. Matthew J. Budway for his input and review of this manuscript.

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

References

  1. 1.
    Rao AA, Laack NN, Giannini C, Wetmore C (2010) Pleomorphic xanthoastrocytoma in children and adolescents. Pediatr Blood Cancer 55:290–294PubMedCrossRefGoogle Scholar
  2. 2.
    Kepes JJ, Rubinstein LJ, Eng LF (1979) Pleomorphic xanthoastrocytoma: a distinctive meningocerebral glioma of young subjects with relatively favorable prognosis. A study of 12 cases. Cancer 44:1839–1852PubMedCrossRefGoogle Scholar
  3. 3.
    Kleihues P, Burger PC, Scheithauer BW (1993) The new WHO classification of brain tumours. Brain Pathol (Zurich, Switzerland) 3:255CrossRefGoogle Scholar
  4. 4.
    Giannini C, Scheithauer BW, Burger PC, Brat DJ, Wollan PC, Lach B, O’Neill BP (1999) Pleomorphic xanthoastrocytoma: what do we really know about it? Cancer 85:2033–2045PubMedGoogle Scholar
  5. 5.
    van Roost D, Kristof R, Zentner J, Wolf HK, Schramm J (1996) Clinical, radiological, and therapeutic features of pleomorphic xanthoastrocytoma: report of three patients and review of the literature. J Neurol Neurosurg Psychiatr 60:690–692PubMedCrossRefGoogle Scholar
  6. 6.
    Bucciero A, De Caro M, De Stefano V, Tedeschi E, Monticelli A, Siciliano A, Cappabianca P, Vizioli L, Cerillo A (1997) Pleomorphic xanthoastrocytoma: clinical, imaging and pathological features of four cases. Clin Neurol Neurosurg 99:40–45PubMedCrossRefGoogle Scholar
  7. 7.
    Marton E, Feletti A, Orvieto E, Longatti P (2007) Malignant progression in pleomorphic xanthoastrocytoma: personal experience and review of the literature. J Neurol Sci 252:144–153PubMedCrossRefGoogle Scholar
  8. 8.
    Ng WH, Lim T, Yeo TT (2008) Pleomorphic xanthoastrocytoma in elderly patients may portend a poor prognosis. J Clin Neurosci 15:476–478PubMedCrossRefGoogle Scholar
  9. 9.
    Tekkok IH, Sav A (2004) Anaplastic pleomorphic xanthoastrocytomas. Review of the literature with reference to malignancy potential. Pediatr Neurosurg 40:171–181PubMedCrossRefGoogle Scholar
  10. 10.
    Passone E, Pizzolitto S, D’Agostini S, Skrap M, Gardiman MP, Nocerino A, Scarzello G, Perilongo G (2006) Non-anaplastic pleomorphic xanthoastrocytoma with neuroradiological evidences of leptomeningeal dissemination. Childs Nerv Syst 22:614–618PubMedCrossRefGoogle Scholar
  11. 11.
    McNatt SA, Gonzalez-Gomez I, Nelson MD, McComb JG (2005) Synchronous multicentric pleomorphic xanthoastrocytoma: case report. Neurosurgery 57:E191 discussion E191PubMedCrossRefGoogle Scholar
  12. 12.
    Lubansu A, Rorive S, David P, Sariban E, Seligmann R, Brotchi J, Pirotte B (2004) Cerebral anaplastic pleomorphic xanthoastrocytoma with meningeal dissemination at first presentation. Childs Nerv Syst 20:119–122PubMedCrossRefGoogle Scholar
  13. 13.
    Asano K, Miyamoto S, Kubo O, Kikkukawa T, Yagihashi A, Ohkuma H (2006) A case of anaplastic pleomorphic xanthoastrocytoma presenting with tumor bleeding and cerebrospinal fluid dissemination. Brain Tumor Pathol 23:55–63PubMedCrossRefGoogle Scholar
  14. 14.
    Nakajima T, Kumabe T, Shamoto H, Watanabe M, Suzuki H, Tominaga T (2006) Malignant transformation of pleomorphic xanthoastrocytoma. Acta Neurochirurgica 148:67–71 discussion 71PubMedCrossRefGoogle Scholar
  15. 15.
    Leonard N, Alcutt DA, Farrell MA (1998) Fatal pleomorphic xanthoastrocytoma with meningeal gliomatosis. Histopathology 32:375–378PubMedCrossRefGoogle Scholar
  16. 16.
    Hamlat A, Le Strat A, Guegan Y, Ben-Hassel M, Saikali S (2007) Cerebellar pleomorphic xanthoastrocytoma: case report and literature review. Surg Neurol 68:89–94 discussion 94-85PubMedCrossRefGoogle Scholar
  17. 17.
    Kurschel S, Lellouch-Tubiana A, Kulkarni AV, Sainte-Rose C (2006) Pleomorphic xanthoastrocytoma of the cerebellopontine angle in a child. Childs Nerv Syst 22:1479–1482PubMedCrossRefGoogle Scholar
  18. 18.
    Heyerdahl Strom E, Skullerud K (1983) Pleomorphic xanthoastrocytoma: report of 5 cases. Clin Neuropathol 2:188–191PubMedGoogle Scholar
  19. 19.
    Kros JM, Vecht CJ, Stefanko SZ (1991) The pleomorphic xanthoastrocytoma and its differential diagnosis: a study of five cases. Hum Pathol 22:1128–1135PubMedCrossRefGoogle Scholar
  20. 20.
    Fouladi M, Jenkins J, Burger P, Langston J, Merchant T, Heideman R, Thompson S, Sanford A, Kun L, Gajjar A (2001) Pleomorphic xanthoastrocytoma: favorable outcome after complete surgical resection. Neuro Oncol 3:184–192PubMedGoogle Scholar
  21. 21.
    Okazaki T, Kageji T, Matsuzaki K, Horiguchi H, Hirose T, Watanabe H, Ohnishi T, Nagahiro S (2009) Primary anaplastic pleomorphic xanthoastrocytoma with widespread neuroaxis dissemination at diagnosis–a pediatric case report and review of the literature. J Neurooncol 94:431–437. doi: 10.1007/s11060-009-9876-6 PubMedCrossRefGoogle Scholar
  22. 22.
    Pahapill PA, Ramsay DA, Del Maestro RF (1996) Pleomorphic xanthoastrocytoma: case report and analysis of the literature concerning the efficacy of resection and the significance of necrosis. Neurosurgery 38:822–828 discussion 828-829PubMedCrossRefGoogle Scholar
  23. 23.
    Macaulay RJ, Jay V, Hoffman HJ, Becker LE (1993) Increased mitotic activity as a negative prognostic indicator in pleomorphic xanthoastrocytoma. Case report. J Neurosurg 79:761–768PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Stephanie M. Perkins
    • 1
    Email author
  • Nandita Mitra
    • 2
  • Wan Fei
    • 2
  • Eric T. Shinohara
    • 1
  1. 1.Department of Radiation OncologyVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of Biostatistics and EpidemiologyUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations