The use and efficacy of chemotherapy and radiotherapy in children and adults with pilocytic astrocytoma

Parsons, M.W.; Whipple, Nicholas; Poppe, Matthew M.; Mendez, Joe; Cannon, Donald M.; Burt, Lindsay

doi:10.1007/s11060-020-03653-y

Cited by 27 publications

(10 citation statements)

References 32 publications

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“…In a Brazilian study including 23 patients, the rate of recurrence was the same after GTR and STR (9%). Interestingly, a study by Parsons et al including 3380 adult patients found no difference in overall survival after GTR or STR [ 34 ]. In our group, two patients were reoperated on in our center after being treated elsewhere: one after partial resection 5 months prior, and the other for recurrence 3 years after partial resection.…”

Section: Discussionmentioning

confidence: 99%

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Insight about the characteristics and surgical resectability of adult pilocytic astrocytoma: tertiary center experience

et al. 2022

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Aim: Adult pilocytic astrocytoma is a rare tumor. We aim to contribute to understanding its clinical course and prognosis. Patients & methods: We searched our database for patients older than 18 years with pathology-proven pilocytic astrocytoma. Patients’ clinical data were analyzed. Results: Fifteen patients were identified. The median age at diagnosis was 25 years (range: 18–56). Tumors were supratentorial in 47%. Gross-total and near-total resections were achieved in 40%, and sub-total resection in 47%. One (7%) recurrence and no mortality were encountered during a median follow-up of 11 months (range: 1–76). Conclusion: Pilocytic astrocytoma behaves differently in adults compared with pediatrics. It tends to arise in surgically challenging areas where the extent of resection may be limited. Total resection should be the main therapy whenever feasible. The survival rates are good, and recurrence is low.

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Section: Discussionmentioning

confidence: 99%

“…Further discussion arises on how patients with incompletely resected tumors should be further managed; whether by observation, radiotherapy and/or chemotherapy [ 34 , 39 , 40 ]. Here again has different studies yielded varying results [ 6 , 18 , 32 , 38 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Insight about the characteristics and surgical resectability of adult pilocytic astrocytoma: tertiary center experience

et al. 2022

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“…Patients are usually followed up by regular imaging as re-resection is advised at recurrence ( 12 ). Because of its long-term benign course, radiation therapy is generally considered in selected cases ( 8 ); palliative care with chemotherapy, radiation therapy, or both is an option for unresectable and multiple recurrent tumors ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study

et al. 2022

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ObjectivePilocytic astrocytomas (PAs) are relatively benign tumors, usually enhancing on post-contrast MRI and often characterized by a mural nodule within a cystic component. Surgical resection represents the mainstay of treatment, and extent of resection (EOR) is associated with improved survival. In this study, we analyzed the effect of sodium fluorescein (SF) on the visualization and resection of these circumscribed astrocytic gliomas.MethodsSurgical databases at two neurosurgical departments (Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy and Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany) were retrospectively reviewed to identify the cohort of patients with pilocytic astrocytoma who had undergone fluorescein-guided tumor resection at any of the centers between March 2016 and February 2022. SF was intravenously injected (5 mg/kg) immediately after the induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW 560 filter (Carl Zeiss Meditec, Oberkochen, Germany).ResultsForty-four patients (25 males and 19 females; 26 pediatric patients, mean age of 9.77 years, range 2 to 17 years; and 18 adult patients, mean age of 34.39 years, range 18 to 58 years) underwent fluorescein-guided surgery. No side effects related to SF occurred. In all tumors, contrast enhancement on preoperative MRI was correlated with intense, heterogeneous yellow fluorescence with bright fluorescent cystic fluid. Fluorescein was considered helpful in distinguishing tumors from viable tissue in all cases except three patients due to faint fluorescein enhancement. Biopsy was intended in two operations, and partial resection was intended in three operations. Gross total resection was achieved in 24 cases out of 39 patients scheduled for tumor removal (61.54%), in five cases a minimal residual volume was highlighted by postoperative MRI despite the intraoperative subjective evaluation of complete tumor removal (12.82%); in the other 10 cases, the resection was subtotal with fluorescent residual spots to avoid neurological worsening (25.64%).ConclusionsThe use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of Pas, suggesting a possible role in improving the extent of resection of these lesions.

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“…In patients that decline surgery or where surgery is not feasible, radiation can be used for tumor control, 17 20 although some studies indicate that radiation and chemotherapy are associated with lower overall survival in PAs compared with surgery or observation alone. 21 Newer agents, such as bevacizumab, have been used to manage recurrent PAs in adults. 22 23 This treatment approach is in contrast to high-grade astrocytomas of the spine, which in adults carry a poor prognosis and require aggressive surgical treatment and postoperative adjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

Pilocytic Astrocytoma Arising from the Conus Medullaris in an Adult: A Case Report

Leclair

Buehler

et al. 2022

Asian J Neurosurg

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Low-grade, sporadic, pilocytic astrocytomas (PAs) are rare spinal cord tumors diagnosed in adult patients. Their localization to the conus medullaris is exceedingly rare, having only been described in a limited number of case reports. Here, we describe a case of a 22-year-old female presenting with back pain, lower extremity weakness, hypoesthesia, and urinary incontinence. Imaging studies demonstrated a cystic lesion of the conus medullaris that was treated with subtotal resection and cyst-subarachnoid shunt placement. Final pathology report confirmed PA from the histology of surgical specimens. We discuss the current literature of conus medullaris lesions and their differential diagnosis.

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The use and efficacy of chemotherapy and radiotherapy in children and adults with pilocytic astrocytoma

Cited by 27 publications

References 32 publications

Insight about the characteristics and surgical resectability of adult pilocytic astrocytoma: tertiary center experience

Insight about the characteristics and surgical resectability of adult pilocytic astrocytoma: tertiary center experience

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study

Pilocytic Astrocytoma Arising from the Conus Medullaris in an Adult: A Case Report

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