Abstract
Purpose: Although a gross total removal of astrocytic tumors offers a favorable prognosis, it is often difficult to achieve in the eloquent area of the brain. This study was conducted to investigate the possible gain of three-dimensional conformal radiotherapy (3DCRT) for astrocytic tumors located in the eloquent area in children and young adults.
Materials and methods: Twenty patients with astrocytic tumors received the radiotherapy. The median age was 17 years, ranging from 4 to 30 years. Fourteen low-grade tumors (seven pilocytic and seven diffuse), and six high-grade tumors (five anaplastic, one malignant pilocytic) were included. Tumors were located at the thalamus/hypothalamus in 12 cases, optic tract in one case, and the deep cerebral/cerebellar hemisphere in seven cases. A specific fixation device was used for 3DCRT. Forty-six Gy for low-grade tumors and 54 Gy for high-grade astrocytomas with 1.8–2.0 Gy per fraction were in principle employed as the standard regimen. Nominal radiotherapy fields ranged from 2.0 × 2.0 to 15.0 × 11.0 cm2. The median follow-up period was 42 months, ranging from 3 to 108 months.
Results: The actuarial survival rate at 5 years was 68% ±13% for all patients. The actuarial survival rate for low-grade glioma was 79% ± 14% at 5 years and 50% ± 20% at 3 years for high-grade glioma. The actual progression-free survival rate was 83% ± 11% at 5 years for low-grade glioma and 50% ± 20% for high-grade glioma. A complete response was obtained in three (21%) of 14 patients with low-grade astrocytic tumors. Two patients with low-grade tumors and four of six with high-grade tumors died due to tumor progression with in-field relapse but not marginal relapse. Twelve survivors with low-grade tumors showed no signs of relapse and no neurological, hormonal, or cognitive deterioration after radiotherapy and were able to attend their school or continue with a full-time job.
Conclusions: 3DCRT is safe and effective for low-grade astrocytic tumors located in the eloquent area in children and young adults.
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Nishihori, T., Shirato, H., Aoyama, H. et al. Three-dimensional Conformal Radiotherapy for Astrocytic Tumors Involving the Eloquent Area in Children and Young Adults. J Neurooncol 60, 177–183 (2002). https://doi.org/10.1023/A:1020617717664
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DOI: https://doi.org/10.1023/A:1020617717664