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Adult pilocytic astrocytoma : The role of adjuvant radiotherapy in residual lesion A Retrospective Analysis on 13 Patients
Author(s): ,
J. Seo
Affiliations:
University of Ulsan College of Medicine, Asan Medical Center, Department of Neurological Surgery, Seoul, Korea, Republic of
Y. Kim
Affiliations:
University of Ulsan College of Medicine, Asan Medical Center, Department of Neurological Surgery, Seoul, Korea, Republic of
EANS Academy. Seo J. Oct 21, 2018; 225662; EP3097
Junghan Seo
Junghan Seo
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Abstract
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Backgrounds: Pilocytic astrocytomas (PAs) frequently affect the pediatric population. On the contrary, rare case series in adults were reported. Some reported adult PA represented more aggressive behavior than pediatric patients. Radiotherapy(RT), chemotherapy or observation with clinical follow-up have been used for residual tumors according to institutional treatment protocol. But there is no definite guidelines for residual adult PAs.

Methods: Retrospective analysis was done for enrolled 13 adult patients who received adjuvant radiotherapy (age > 18 years) after diagnosed of pilocytic astrocytoma by surgery in single institution. Overall survivial, progression free survivial and prognostic factors were analyzed

Results: There were 6 men and 7 women with mean age of 35.4 year. The locations of the tumor were thalamus or basal ganglia (4 cases), cerebellum (3 cases), brain stem (3 cases), ventricle (2 cases) and cerebrum (1 case)
Complete resection was achieved in only 1 patient. Partial resection and biopsy was done in 5 (38.4%) and 7 patients (53.8%), respectively. 3 Patients received Gamma-knife radiosurgery. And 10 patients received WBRT with mean radiation dose of 52.67 Gy.
During the median follow-up of 65 months, progression after radiotherapy was observed in 8 cases (61.5%). While 1 patient who progressed 22months after RT improved 36months after RT. Decrease of tumor size was observed in 3 cases (23.1%). Stable state was observed in 2 patients (15.4%).
The actuarial OS rates at 3, 5 years were 69.2%, 61.5%. 4 patients were dead and their mean OS was 15.4 months. Mean PFS of 13 patients was 47.4 months.

Conclusion: Adult PA has more aggressive clinical behavior than pediatric PAs. In some cases, it is impossible to achieve complete resection of the tumor due to its location and expected morbidities. We suggest adjuvant radiotherapy can be helpful in some cases of residual PAs
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