Outcomes of stereotactic radiosurgery for pilocytic astrocytoma: an international multiinstitutional study

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  • 1 Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio;
  • 2 Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
  • 3 Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;
  • 4 Department of Functional Neurosurgery and Radiosurgery, Ruber International Hospital, Madrid, Spain;
  • 5 Department of Neurosurgery, New York University Langone Medical Center, New York, New York;
  • 6 Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;
  • 7 Division of Neurosurgery, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada;
  • 8 Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China;
  • 9 Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;
  • 10 Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China;
  • 11 Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida;
  • 12 Department of Neurosurgery, University of Louisville, Kentucky; and
  • 13 Rose-Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio
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OBJECTIVE

The current standard initial therapy for pilocytic astrocytoma is maximal safe resection. Radiation therapy is considered for residual, recurrent, or unresectable pilocytic astrocytomas. However, the optimal radiation strategy has not yet been established. Here, the authors describe the outcomes of stereotactic radiosurgery (SRS) for pilocytic astrocytoma in a large multiinstitutional cohort.

METHODS

An institutional review board–approved multiinstitutional database of patients treated with Gamma Knife radiosurgery (GKRS) between 1990 and 2016 was queried. Data were gathered from 9 participating International Radiosurgery Research Foundation (IRRF) centers. Patients with a histological diagnosis of pilocytic astrocytoma treated using a single session of GKRS and with at least 6 months of follow-up were included in the analysis.

RESULTS

A total of 141 patients were analyzed in the study. The median patient age was 14 years (range 2–84 years) at the time of GKRS. The median follow-up was 67.3 months. Thirty-nine percent of patients underwent SRS as the initial therapy, whereas 61% underwent SRS as salvage treatment. The median tumor volume was 3.45 cm3. The tumor location was the brainstem in 30% of cases, with a nonbrainstem location in the remainder. Five- and 10-year overall survival rates at the last follow-up were 95.7% and 92.5%, respectively. Five- and 10-year progression-free survival (PFS) rates were 74.0% and 69.7%, respectively. On univariate analysis, an age < 18 years, tumor volumes < 4.5 cm3, and no prior radiotherapy or chemotherapy were identified as positive prognostic factors for improved PFS. On multivariate analysis, only prior radiotherapy was significant for worse PFS.

CONCLUSIONS

This represents the largest study of single-session GKRS for pilocytic astrocytoma to date. Favorable long-term PFS and overall survival were observed with GKRS. Further prospective studies should be performed to evaluate appropriate radiosurgery dosing, timing, and sequencing of treatment along with their impact on toxicity and the quality of life of patients with pilocytic astrocytoma.

ABBREVIATIONS GKRS = Gamma Knife radiosurgery; PA = pilocytic astrocytoma; PFS = progression-free survival; SRS = stereotactic radiosurgery.

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Contributor Notes

Correspondence Erin S. Murphy: Taussig Cancer Center, Cleveland Clinic, Cleveland, OH. murphye3@ccf.org.

INCLUDE WHEN CITING Published online November 29, 2019; DOI: 10.3171/2019.9.JNS191335.

Disclosures Dr. Trifiletti receives clinical trial research support from Novocure and publishing fees from Springer Inc., unrelated to this submitted work. Dr. Kondziolka receives research support from BrainLab, unrelated to this submitted work.

  • 1

    Barcia JA, Barcia-Salorio JL, Ferrer C, Ferrer E, Algás R, Hernández G: Stereotactic radiosurgery of deeply seated low grade gliomas. Acta Neurochir Suppl (Wien) 62:5861, 1994

    • Search Google Scholar
    • Export Citation
  • 2

    Boëthius J, Ulfarsson E, Rähn T, Lippittz B: Gamma knife radiosurgery for pilocytic astrocytomas. J Neurosurg 97 (5 Suppl):677680, 2002

    • Search Google Scholar
    • Export Citation
  • 3

    Effinger KE, Stratton KL, Fisher PG, Ness KK, Krull KR, Oeffinger KC, : Long-term health and social function in adult survivors of paediatric astrocytoma: a report from the Childhood Cancer Survivor Study. Eur J Cancer 106:171180, 2019

    • Search Google Scholar
    • Export Citation
  • 4

    Fangusaro JR, Onar-Thomas A, Young-Poussaint T, Wu S, Ligon AH, Lindeman NI, : A phase II prospective study of selumetinib in children with recurrent or refractory low-grade glioma (LGG): a Pediatric Brain Tumor Consortium (PBTC) study. Neuro Oncol 19:iv34iv35, 2017

    • Search Google Scholar
    • Export Citation
  • 5

    Gajjar A, Sanford RA, Heideman R, Jenkins JJ, Walter A, Li Y, : Low-grade astrocytoma: a decade of experience at St. Jude Children’s Research Hospital. J Clin Oncol 15:27922799, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Hadjipanayis CG, Kondziolka D, Gardner P, Niranjan A, Dagam S, Flickinger JC, : Stereotactic radiosurgery for pilocytic astrocytomas when multimodal therapy is necessary. J Neurosurg 97:5664, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Henderson MA, Fakiris AJ, Timmerman RD, Worth RM, Lo SS, Witt TC: Gamma knife stereotactic radiosurgery for low-grade astrocytomas. Stereotact Funct Neurosurg 87:161167, 2009

    • Search Google Scholar
    • Export Citation
  • 8

    Hodgson DC, Goumnerova LC, Loeffler JS, Dutton S, Black PM, Alexander E III, : Radiosurgery in the management of pediatric brain tumors. Int J Radiat Oncol Biol Phys 50:929935, 2001

    • Search Google Scholar
    • Export Citation
  • 9

    Hoffman LM, Plimpton SR, Foreman NK, Stence NV, Hankinson TC, Handler MH, : Fractionated stereotactic radiosurgery for recurrent ependymoma in children. J Neurooncol 116:107111, 2014

    • Search Google Scholar
    • Export Citation
  • 10

    Hua C, Bass JK, Khan R, Kun LE, Merchant TE: Hearing loss after radiotherapy for pediatric brain tumors: effect of cochlear dose. Int J Radiat Oncol Biol Phys 72:892899, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Johnson DR, Brown PD, Galanis E, Hammack JE: Pilocytic astrocytoma survival in adults: analysis of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. J Neurooncol 108:187193, 2012

    • Search Google Scholar
    • Export Citation
  • 12

    Kano H, Niranjan A, Kondziolka D, Flickinger JC, Pollack IF, Jakacki RI, : Stereotactic radiosurgery for pilocytic astrocytomas part 2: outcomes in pediatric patients. J Neurooncol 95:219229, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Kano H, Yang HC, Kondziolka D, Niranjan A, Arai Y, Flickinger JC, : Stereotactic radiosurgery for pediatric recurrent intracranial ependymomas. J Neurosurg Pediatr 6:417423, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Kida Y, Kobayashi T, Mori Y: Gamma knife radiosurgery for low-grade astrocytomas: results of long-term follow up. J Neurosurg 93 (Suppl 3):4246, 2000

    • Search Google Scholar
    • Export Citation
  • 15

    Laughton SJ, Merchant TE, Sklar CA, Kun LE, Fouladi M, Broniscer A, : Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial. J Clin Oncol 26:11121118, 2008

    • Search Google Scholar
    • Export Citation
  • 16

    Mansur DB, Rubin JB, Kidd EA, King AA, Hollander AS, Smyth MD, : Radiation therapy for pilocytic astrocytomas of childhood. Int J Radiat Oncol Biol Phys 79:829834, 2011

    • Search Google Scholar
    • Export Citation
  • 17

    Merchant TE, Boop FA, Kun LE, Sanford RA: A retrospective study of surgery and reirradiation for recurrent ependymoma. Int J Radiat Oncol Biol Phys 71:8797, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    Merchant TE, Li C, Xiong X, Kun LE, Boop FA, Sanford RA: Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study. Lancet Oncol 10:258266, 2009

    • Search Google Scholar
    • Export Citation
  • 19

    Miké V, Meadows AT, D’Angio GJ: Incidence of second malignant neoplasms in children: results of an international study. Lancet 2:13261331, 1982

    • Search Google Scholar
    • Export Citation
  • 20

    Mulhern RK, Palmer SL, Merchant TE, Wallace D, Kocak M, Brouwers P, : Neurocognitive consequences of risk-adapted therapy for childhood medulloblastoma. J Clin Oncol 23:55115519, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Murphy ES, Merchant TE, Wu S, Xiong X, Lukose R, Wright KD, : Necrosis after craniospinal irradiation: results from a prospective series of children with central nervous system embryonal tumors. Int J Radiat Oncol Biol Phys 83:e655e660, 2012

    • Search Google Scholar
    • Export Citation
  • 22

    Neglia JP, Robison LL, Stovall M, Liu Y, Packer RJ, Hammond S, : New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 98:15281537, 2006

    • Search Google Scholar
    • Export Citation
  • 23

    Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, : CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009–2013. Neuro Oncol 18 (suppl_5):v1v75, 2016

    • Search Google Scholar
    • Export Citation
  • 24

    PDQ® Pediatric Treatment Editorial Board: PDQ® Childhood Astrocytomas Treatment. Bethesda, MD: National Cancer Institute, 2009 (https://www.cancer.gov/types/brain/hp/child-astrocytoma-treament-pdq) [Accessed September 27, 2019]

    • Search Google Scholar
    • Export Citation
  • 25

    Reis GF, Tihan T: Therapeutic targets in pilocytic astrocytoma based on genetic analysis. Semin Pediatr Neurol 22:2327, 2015

  • 26

    Ris MD, Packer R, Goldwein J, Jones-Wallace D, Boyett JM: Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for medulloblastoma: a Children’s Cancer Group study. J Clin Oncol 19:34703476, 2001

    • Search Google Scholar
    • Export Citation
  • 27

    Simonova G, Kozubikova P, Liscak R, Novotny J Jr: Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results. J Neurosurg Pediatr 18:5864, 2016

    • Search Google Scholar
    • Export Citation
  • 28

    Somaza SC, Kondziolka D, Lunsford LD, Flickinger JC, Bissonette DJ, Albright AL: Early outcomes after stereotactic radiosurgery for growing pilocytic astrocytomas in children. Pediatr Neurosurg 25:109115, 1996

    • Search Google Scholar
    • Export Citation
  • 29

    Stafford SL, Pollock BE, Foote RL, Gorman DA, Nelson DF, Schomberg PJ: Stereotactic radiosurgery for recurrent ependymoma. Cancer 88:870875, 2000

    • Search Google Scholar
    • Export Citation
  • 30

    Stauder MC, Ni Laack N, Ahmed KA, Link MJ, Schomberg PJ, Pollock BE: Stereotactic radiosurgery for patients with recurrent intracranial ependymomas. J Neurooncol 108:507512, 2012

    • Search Google Scholar
    • Export Citation
  • 31

    Trifiletti DM, Peach MS, Xu Z, Kersh R, Showalter TN, Sheehan JP: Evaluation of outcomes after stereotactic radiosurgery for pilocytic astrocytoma. J Neurooncol 134:297302, 2017

    • Search Google Scholar
    • Export Citation
  • 32

    Weintraub D, Yen CP, Xu Z, Savage J, Williams B, Sheehan J: Gamma knife surgery of pediatric gliomas. J Neurosurg Pediatr 10:471477, 2012

    • Search Google Scholar
    • Export Citation
  • 33

    Wisoff JH, Sanford RA, Heier LA, Sposto R, Burger PC, Yates AJ, : Primary neurosurgery for pediatric low-grade gliomas: a prospective multi-institutional study from the Children’s Oncology Group. Neurosurgery 68:15481555, 2011

    • Search Google Scholar
    • Export Citation

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