Long-term radiosurgical control of subtotally resected adult pineocytomas

Clinical article

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Object

The optimal management of pineocytomas remains controversial. Although the value of complete microsurgical removal is well accepted, gross-total resection is not always feasible. Data regarding the role of postoperative adjuvant stereotactic radiosurgery (SRS) for residual disease is limited and conflicting. Here, the authors review the largest single-institution experience with multimodal pineocytoma management in an effort to quantify the utility of adjuvant radiosurgical treatment of residual disease.

Methods

The medical records and radiographic studies for all patients with histologically confirmed pineocytoma at the Barrow Neurological Institute between 1999 and 2011 were retrospectively reviewed. Clinical and radiographic data, including the volumetric extent of resection, were collected retrospectively, and Kaplan-Meier analysis was used to identify progression-free survival.

Results

Fourteen adults with newly diagnosed pineocytomas were surgically treated in the period from 1999 to 2011. The median clinical and radiographic follow-ups were 44 and 53 months, respectively. Twelve patients (86%) underwent microsurgical removal and 2 (14%) underwent endoscopic biopsy. Five patients (36%) had complete resections and 9 (64%) demonstrated residual disease. Three patients (21%) presented with radiographic recurrence at a median interval of 43 months after initial treatment (range 13–83 months). At the time of recurrence, the median preoperative tumor volume was 2.6 cm3. Adjuvant SRS was used to treat 3 subtotally resected tumors (33%) following initial presentation and 2 (66%) at the time of recurrence. Among patients with subtotally resected tumors, progression-free survival was significantly longer (p < 0.05) for those who did as compared with those who did not undergo adjuvant radiosurgery. To date, no patient who underwent adjuvant radiosurgery has demonstrated radiographic or clinical evidence of disease progression.

Conclusions

Microsurgical removal remains the definitive treatment for pineocytomas, yet residual disease can be effectively controlled using adjuvant SRS.

Abbreviations used in this paper:GTR = gross-total resection; SCIT = supracerebellar-infratentorial; SRS = stereotactic radiosurgery; STR = subtotal resection.

Article Information

Address correspondence to: Nader Sanai, M.D., Barrow Neurological Institute, 310 North Third Avenue, Phoenix, Arizona 85013. email: Nader.Sanai@bnaneuro.net.

Please include this information when citing this paper: published online June 15, 2012; DOI: 10.3171/2012.5.JNS1251.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph showing number of patients with disease progression by treatment type. Including the 2 instances of recurrent disease requiring repeat treatment, 13 cases of pineocytomas were treated and had radiographic follow-up. Among the patients in these cases, none who underwent GTR or STR+SRS experienced progression. All cases of progression occurred in the cohort that underwent STR alone. Lined bars, progression; gray bars, no progression.

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    Kaplan-Meier curve showing long-term tumor control in STR and STR+SRS cohorts. There was a significantly longer (log-rank p < 0.05) progression-free interval when adjuvant radiosurgery was used to treat subtotally resected lesions.

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    Kaplan-Meier curve demonstrating long-term tumor control in STR versus GTR and STR+SRS cohorts. Subtotal resection alone was associated with a significantly shorter (p < 0.05, log-rank test) time to progression as compared with GTR or STR+SRS.

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    Case 1. Magnetic resonance images obtained in a 48-yearold female. A symptomatic pineal lesion (A) was treated with STR. Pathology revealed pineocytoma. Thirteen months later, the patient's symptoms worsened, and MRI demonstrated disease progression (B). She subsequently underwent repeat STR and postoperative radiosurgery (16 Gy to the 50% isodose line). Magnetic resonance image (C) obtained after repeat surgery and prior to radiosurgery, showing tumor control. Follow-up MR image (D) obtained 9 years after adjuvant radiosurgery, demonstrating continued partial remission.

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    Case 2. Magnetic resonance images obtained in a 37-year-old female who presented with chronic headaches. An MR image demonstrating a pineal lesion (A). The patient underwent STR. Magnetic resonance image (B) obtained immediately postoperatively showing residual disease. Pathology revealed pineocytoma, and she underwent adjuvant radiosurgery (14 Gy to the 50% isodose line). Follow-up MR image obtained 6 years after treatment, demonstrating near-complete remission (C).

References

  • 1

    Amendola BEWolf ACoy SRAmendola MAEber D: Pineal tumors: analysis of treatment results in 20 patients. J Neurosurg 102:Suppl1751792005

    • Search Google Scholar
    • Export Citation
  • 2

    Broggi MDarbar ATeo C: The value of endoscopy in the total resection of pineocytomas. Neurosurgery 67:3 Suppl Operativeons159ons1652010

    • Search Google Scholar
    • Export Citation
  • 3

    Bruce JNStein BM: Surgical management of pineal region tumors. Acta Neurochir (Wien) 134:1301351995

  • 4

    Clark AJIvan MESughrue MEYang IAranda DHan SJ: Tumor control after surgery and radiotherapy for pineocytoma. Clinical article. J Neurosurg 113:3193242010

    • Search Google Scholar
    • Export Citation
  • 5

    Clark AJSughrue MEAranda DParsa AT: Contemporary management of pineocytoma. Neurosurg Clin N Am 22:403407ix2011

  • 6

    Clark AJSughrue MEIvan MEAranda DRutkowski MJKane AJ: Factors influencing overall survival rates for patients with pineocytoma. J Neurooncol 100:2552602010

    • Search Google Scholar
    • Export Citation
  • 7

    de Oliveira JGLekovic GPSafavi-Abbasi SReis CVHanel RAPorter RW: Supracerebellar infratentorial approach to cavernous malformations of the brainstem: surgical variants and clinical experience with 45 patients. Neurosurgery 66:3893992010

    • Search Google Scholar
    • Export Citation
  • 8

    Deshmukh VRSmith KARekate HLCoons SSpetzler RF: Diagnosis and management of pineocytomas. Neurosurgery 55:3493572004

  • 9

    Hasegawa TKondziolka DHadjipanayis CGFlickinger JCLunsford LD: The role of radiosurgery for the treatment of pineal parenchymal tumors. Neurosurgery 51:8808892002

    • Search Google Scholar
    • Export Citation
  • 10

    Kano HNiranjan AKondziolka DFlickinger JCLunsford D: Role of stereotactic radiosurgery in the management of pineal parenchymal tumors. Prog Neurol Surg 23:44582009

    • Search Google Scholar
    • Export Citation
  • 11

    Kobayashi TKida YMori Y: Stereotactic gamma radiosurgery for pineal and related tumors. J Neurooncol 54:3013092001

  • 12

    Konovalov ANPitskhelauri DI: Principles of treatment of the pineal region tumors. Surg Neurol 59:2502682003

  • 13

    Lekovic GPGonzalez LFShetter AGPorter RWSmith KABrachman D: Role of Gamma Knife surgery in the management of pineal region tumors. Neurosurg Focus 23:6E122007

    • Search Google Scholar
    • Export Citation
  • 14

    Mori YKobayashi THasegawa TYoshida KKida Y: Stereotactic radiosurgery for pineal and related tumors. Prog Neurol Surg 23:1061182009

    • Search Google Scholar
    • Export Citation
  • 15

    Regis JBouillot PRouby-Volot FFigarella-Branger DDufour HPeragut JC: Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery 39:9079141996

    • Search Google Scholar
    • Export Citation
  • 16

    Reyns NHayashi MChinot OManera LPéragut JCBlond S: The role of Gamma Knife radiosurgery in the treatment of pineal parenchymal tumours. Acta Neurochir (Wien) 148:5112006

    • Search Google Scholar
    • Export Citation
  • 17

    Stoiber EMSchaible BHerfarth KSchulz-Ertner DHuber PEDebus J: Long term outcome of adolescent and adult patients with pineal parenchymal tumors treated with fractionated radiotherapy between 1982 and 2003—a single institution's experience. Radiat Oncol 5:1222010

    • Search Google Scholar
    • Export Citation

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