Adult Pilocytic Astrocytoma: An Institutional Series and Systematic Literature Review for Extent of Resection and Recurrence

Kamila M. Bond, Joshua D. Hughes, Amanda L. Porter, Josiah Orina, Shanna Fang, Ian F. Parney

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

Introduction Pilocytic astrocytoma is a classically benign tumor that most often affects pediatric patients. Rarely, it occurs during adulthood. We present a case series and systematic literature review of adult pilocytic astrocytoma (APA) to examine the clinical presentation, extent of resection, and recurrence rate associated with this tumor in this population. Materials and Methods Our institutional records were retrospectively reviewed for cases of pilocytic astrocytoma in adults. A PubMed search identified English-language studies of pathology-proven APA. A meta-analysis was performed to determine the relationship between extent of tumor resection and recurrence. Results Forty-six patients with APA were diagnosed at our institution (mean age 33.6 ± 13.3; 24 [52%] female). Twenty-four patients (52%) underwent gross total resection, 11 (24%) subtotal resection, 4 (9%) near total resection, 4 (9%) observation after biopsy, and 3 (6%) radiotherapy alone. Tumors recurred or progressed in 6 (13%) patients, of whom 4 were treated by STR and 2 were treated by radiotherapy alone. Thirty-nine (95%) patients were still alive at last follow-up. A systematic literature review identified 415 patients with APA in 38 studies. Including our case series, 7 studies reported extent of resection, follow-up, and recurrence. Of 254 patients with a weighted mean follow-up of 77.7 ± 49.6 (31–250) months, 129 (51%) were treated with gross total resection, and 125 (49%) underwent subtotal resection. Tumor recurred in 79 (31%) patients, 22 (27%) after gross total resection and 57 (73%) after subtotal resection (P < 0.001). Conclusions Pilocytic astrocytoma rarely presents during adulthood. Overall, prognosis is favorable and survival rates are high. APA recurrence is more likely after STR, and the goal of surgery should always be GTR when feasible.

Original languageEnglish (US)
Pages (from-to)276-283
Number of pages8
JournalWorld Neurosurgery
Volume110
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Fingerprint

Astrocytoma
Recurrence
Neoplasms
Radiotherapy
Speech-Language Pathology
PubMed
Meta-Analysis
Survival Rate
Observation
Pediatrics
Biopsy
Population

Keywords

  • Adult pilocytic astrocytoma
  • Literature review

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Adult Pilocytic Astrocytoma : An Institutional Series and Systematic Literature Review for Extent of Resection and Recurrence. / Bond, Kamila M.; Hughes, Joshua D.; Porter, Amanda L.; Orina, Josiah; Fang, Shanna; Parney, Ian F.

In: World Neurosurgery, Vol. 110, 01.02.2018, p. 276-283.

Research output: Contribution to journalReview article

Bond, Kamila M. ; Hughes, Joshua D. ; Porter, Amanda L. ; Orina, Josiah ; Fang, Shanna ; Parney, Ian F. / Adult Pilocytic Astrocytoma : An Institutional Series and Systematic Literature Review for Extent of Resection and Recurrence. In: World Neurosurgery. 2018 ; Vol. 110. pp. 276-283.
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title = "Adult Pilocytic Astrocytoma: An Institutional Series and Systematic Literature Review for Extent of Resection and Recurrence",
abstract = "Introduction Pilocytic astrocytoma is a classically benign tumor that most often affects pediatric patients. Rarely, it occurs during adulthood. We present a case series and systematic literature review of adult pilocytic astrocytoma (APA) to examine the clinical presentation, extent of resection, and recurrence rate associated with this tumor in this population. Materials and Methods Our institutional records were retrospectively reviewed for cases of pilocytic astrocytoma in adults. A PubMed search identified English-language studies of pathology-proven APA. A meta-analysis was performed to determine the relationship between extent of tumor resection and recurrence. Results Forty-six patients with APA were diagnosed at our institution (mean age 33.6 ± 13.3; 24 [52{\%}] female). Twenty-four patients (52{\%}) underwent gross total resection, 11 (24{\%}) subtotal resection, 4 (9{\%}) near total resection, 4 (9{\%}) observation after biopsy, and 3 (6{\%}) radiotherapy alone. Tumors recurred or progressed in 6 (13{\%}) patients, of whom 4 were treated by STR and 2 were treated by radiotherapy alone. Thirty-nine (95{\%}) patients were still alive at last follow-up. A systematic literature review identified 415 patients with APA in 38 studies. Including our case series, 7 studies reported extent of resection, follow-up, and recurrence. Of 254 patients with a weighted mean follow-up of 77.7 ± 49.6 (31–250) months, 129 (51{\%}) were treated with gross total resection, and 125 (49{\%}) underwent subtotal resection. Tumor recurred in 79 (31{\%}) patients, 22 (27{\%}) after gross total resection and 57 (73{\%}) after subtotal resection (P < 0.001). Conclusions Pilocytic astrocytoma rarely presents during adulthood. Overall, prognosis is favorable and survival rates are high. APA recurrence is more likely after STR, and the goal of surgery should always be GTR when feasible.",
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T2 - An Institutional Series and Systematic Literature Review for Extent of Resection and Recurrence

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AU - Orina, Josiah

AU - Fang, Shanna

AU - Parney, Ian F.

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N2 - Introduction Pilocytic astrocytoma is a classically benign tumor that most often affects pediatric patients. Rarely, it occurs during adulthood. We present a case series and systematic literature review of adult pilocytic astrocytoma (APA) to examine the clinical presentation, extent of resection, and recurrence rate associated with this tumor in this population. Materials and Methods Our institutional records were retrospectively reviewed for cases of pilocytic astrocytoma in adults. A PubMed search identified English-language studies of pathology-proven APA. A meta-analysis was performed to determine the relationship between extent of tumor resection and recurrence. Results Forty-six patients with APA were diagnosed at our institution (mean age 33.6 ± 13.3; 24 [52%] female). Twenty-four patients (52%) underwent gross total resection, 11 (24%) subtotal resection, 4 (9%) near total resection, 4 (9%) observation after biopsy, and 3 (6%) radiotherapy alone. Tumors recurred or progressed in 6 (13%) patients, of whom 4 were treated by STR and 2 were treated by radiotherapy alone. Thirty-nine (95%) patients were still alive at last follow-up. A systematic literature review identified 415 patients with APA in 38 studies. Including our case series, 7 studies reported extent of resection, follow-up, and recurrence. Of 254 patients with a weighted mean follow-up of 77.7 ± 49.6 (31–250) months, 129 (51%) were treated with gross total resection, and 125 (49%) underwent subtotal resection. Tumor recurred in 79 (31%) patients, 22 (27%) after gross total resection and 57 (73%) after subtotal resection (P < 0.001). Conclusions Pilocytic astrocytoma rarely presents during adulthood. Overall, prognosis is favorable and survival rates are high. APA recurrence is more likely after STR, and the goal of surgery should always be GTR when feasible.

AB - Introduction Pilocytic astrocytoma is a classically benign tumor that most often affects pediatric patients. Rarely, it occurs during adulthood. We present a case series and systematic literature review of adult pilocytic astrocytoma (APA) to examine the clinical presentation, extent of resection, and recurrence rate associated with this tumor in this population. Materials and Methods Our institutional records were retrospectively reviewed for cases of pilocytic astrocytoma in adults. A PubMed search identified English-language studies of pathology-proven APA. A meta-analysis was performed to determine the relationship between extent of tumor resection and recurrence. Results Forty-six patients with APA were diagnosed at our institution (mean age 33.6 ± 13.3; 24 [52%] female). Twenty-four patients (52%) underwent gross total resection, 11 (24%) subtotal resection, 4 (9%) near total resection, 4 (9%) observation after biopsy, and 3 (6%) radiotherapy alone. Tumors recurred or progressed in 6 (13%) patients, of whom 4 were treated by STR and 2 were treated by radiotherapy alone. Thirty-nine (95%) patients were still alive at last follow-up. A systematic literature review identified 415 patients with APA in 38 studies. Including our case series, 7 studies reported extent of resection, follow-up, and recurrence. Of 254 patients with a weighted mean follow-up of 77.7 ± 49.6 (31–250) months, 129 (51%) were treated with gross total resection, and 125 (49%) underwent subtotal resection. Tumor recurred in 79 (31%) patients, 22 (27%) after gross total resection and 57 (73%) after subtotal resection (P < 0.001). Conclusions Pilocytic astrocytoma rarely presents during adulthood. Overall, prognosis is favorable and survival rates are high. APA recurrence is more likely after STR, and the goal of surgery should always be GTR when feasible.

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