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Early or delayed radiosurgery for WHO grade II astrocytomas

  • Clinical Study – Patient Study
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Abstract

To evaluate the role of gamma knife stereotactic radiosurgery (SRS) in the management of newly diagnosed (early) or progressive (delayed) WHO grade II astrocytomas, the authors reviewed 25 patients who underwent SRS for pathologically proven WHO grade II astrocytomas between 1987 and 2009 at the University of Pittsburgh. The median patient age was 30 years (range 8–68 years). Sixteen patients had early SRS after stereotactic biopsy (n = 14), resection (n = 1) or radiation therapy (n = 1), and 9 underwent delayed SRS for progression after surgical resection (n = 3), radiation therapy (n = 4) or both (n = 2). The median tumor volume was 3.7 cm3 (range 0.6–17.0 cm3) and the median margin dose was 14 Gy (range 11–20 Gy). At a median of 65 months of follow-up (range 6–208 months), tumor control was observed in 13 patients (52%). The progression-free survival rates after SRS at 1, 5 and 10 years were 91.3, 54.1 and 37.1%, respectively. On both univariate and multivariate analysis smaller tumor volume (<6 cm3), higher marginal dose (≥15 Gy) and absence of contrast enhancement on imaging studies were associated with better progression free-survival. Gamma knife SRS is an additional option for patients with small volume, deep seated, non-enhancing and well-demarcated WHO grade II astrocytomas and does not preclude later conventional fractionated radiation therapy, cyst aspiration, or cautious debulking if feasible. It may also benefit patients with residual or recurrent tumors that have progressed after surgery, radiation therapy or both.

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References

  1. Laws ER Jr, Taylor WF, Clifton MB, Okazaki H (1984) Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61:665–673

    Article  PubMed  Google Scholar 

  2. McCormack BM, Miller DC, Budzilovich GN, Voorhees GJ, Ransohoff J (1992) Treatment and survival of low-grade astrocytoma in adults–1977–1988. Neurosurgery 31:636–642; discussion 642

    Article  PubMed  CAS  Google Scholar 

  3. Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Knisel JP, Lacy J, Tsukerman L, Makuch R (1996) Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. Neurosurgery 38:872–878; discussion 878–879

    Article  PubMed  CAS  Google Scholar 

  4. Eyre HJ, Crowley JJ, Townsend JJ, Eltringham JR, Morantz RA, Schulman SF, Quagliana JM, al Sarraf M (1993) A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: a Southwest Oncology Group study. J Neurosurg 78:909–914

    Article  PubMed  CAS  Google Scholar 

  5. Janny P, Cure H, Mohr M, Heldt N, Kwiatkowski F, Lemaire JJ, Plagne R, Rozan R (1994) Low grade supratentorial astrocytomas. Management and prognostic factors. Cancer 73:1937–1945

    Article  PubMed  CAS  Google Scholar 

  6. Keles GE, Lamborn KR, Berger MS (2001) Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:735–745

    Article  PubMed  CAS  Google Scholar 

  7. Leighton C, Fisher B, Bauman G, Depiero S, Stitt L, MacDonald D, Cairncross G (1997) Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 15:1294–1301

    PubMed  CAS  Google Scholar 

  8. Piepmeier J, Baehring JM (2004) Surgical resection for patients with benign primary brain tumors and low grade gliomas. J Neurooncol 69:55–65

    Article  PubMed  Google Scholar 

  9. Berger MS, Deliganis AV, Dobbins J, Keles GE (1994) The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74:1784–1791

    Article  PubMed  CAS  Google Scholar 

  10. McGirt MJ, Chaichana KL, Attenello FJ, Weingart JD, Than K, Burger PC, Olivi A, Brem H, Quinones-Hinojosa A (2008) Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 63:700–707 Author Reply: 707–708

    Article  PubMed  Google Scholar 

  11. Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW, Berger MS (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345

    Article  PubMed  Google Scholar 

  12. Chaichana KL, McGirt MJ, Laterra J, Olivi A, Quinones-Hinojosa A (2010) Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas. J Neurosurg 112:10–17

    Article  PubMed  Google Scholar 

  13. Davis FS (2007) Epidemiology of brain tumors. Expert Rev Anticancer Ther 7:S3–S6

    Article  PubMed  Google Scholar 

  14. Lunsford LD, Somaza S, Kondziolka D, Flickinger JC (1995) Survival after stereotactic biopsy and irradiation of cerebral nonanaplastic, nonpilocytic astrocytoma. J Neurosurg 82:523–529

    Article  PubMed  CAS  Google Scholar 

  15. Duffau H, Capelle L, Lopes M, Faillot T, Sichez JP, Fohanno D (2000) The insular lobe: physiopathological and surgical considerations. Neurosurgery 47:801–810; discussion 810–811

    Article  PubMed  CAS  Google Scholar 

  16. Duffau H, Capelle L, Lopes M, Bitar A, Sichez JP, van Effenterre R (2002) Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy. Acta Neurochir (Wien) 144:563–572; discussion 572–573

    Article  CAS  Google Scholar 

  17. Brell M, Conesa G, Acebes JJ (2003) Intraoperative cortical mapping in the surgical resection of low-grade gliomas located in eloquent areas. Neurocirugia (Astur) 14:491–503

    CAS  Google Scholar 

  18. Mehrkens JH, Kreth FW, Muacevic A, Ostertag CB (2004) Long term course of WHO grade II astrocytomas of the Insula of Reil after I-125 interstitial irradiation. J Neurol 251:1455–1464

    Article  PubMed  Google Scholar 

  19. Lang FF, Olansen NE, De Monte F, Gokaslan ZL, Holland EC, Kalhorn C, Sawaya R (2001) Surgical resection of intrinsic insular tumors: complication avoidance. J Neurosurg 95:638–650

    Article  PubMed  CAS  Google Scholar 

  20. Peraud A, Ilmberger J, Reulen HJ (2004) Surgical resection of gliomas WHO grade II and III located in the opercular region. Acta Neurochir (Wien) 146:9–17; discussion 17–18

    Article  CAS  Google Scholar 

  21. Peraud A, Meschede M, Eisner W, Ilmberger J, Reulen HJ (2002) Surgical resection of grade II astrocytomas in the superior frontal gyrus. Neurosurgery 50:966–975; discussion 975–967

    PubMed  Google Scholar 

  22. Schomas DA, Laack NN, Brown PD (2009) Low-grade gliomas in older patients: long-term follow-up from Mayo Clinic. Cancer 115:3969–3978

    Article  PubMed  Google Scholar 

  23. Schomas DA, Laack NN, Rao RD, Meyer FB, Shaw EG, O’Neill BP, Giannini C, Brown PD (2009) Intracranial low-grade gliomas in adults: 30-year experience with long-term follow-up at Mayo Clinic. Neuro Oncol 11:437–445

    Article  PubMed  Google Scholar 

  24. Shaw EG, Daumas-Duport C, Scheithauer BW, Gilbertson DT, O’Fallon JR, Earle JD, Laws ER Jr, Okazaki H (1989) Radiation therapy in the management of low-grade supratentorial astrocytomas. J Neurosurg 70:853–861

    Article  PubMed  CAS  Google Scholar 

  25. Shibamoto Y, Kitakabu Y, Takahashi M, Yamashita J, Oda Y, Kikuchi H, Abe M (1993) Supratentorial low-grade astrocytoma. Correlation of computed tomography findings with effect of radiation therapy and prognostic variables. Cancer 72:190–195

    Article  PubMed  CAS  Google Scholar 

  26. van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmstrom PO, Collette L, Pierart M, Mirimanoff R, Karim AB (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366:985–990

    Article  PubMed  Google Scholar 

  27. Schultheiss TE, Kun LE, Ang KK, Stephens LC (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31:1093–1112

    Article  PubMed  CAS  Google Scholar 

  28. Kida Y, Kobayashi T, Mori Y (2000) Gamma knife radiosurgery for low-grade astrocytomas: results of long-term follow up. J Neurosurg 93(Suppl 3):42–46

    PubMed  Google Scholar 

  29. Hadjipanayis CG, Niranjan A, Tyler-Kabara E, Kondziolka D, Flickinger JC, Lunsford LD (2002) Stereotactic radiosurgery for well-circumscribed fibrillary grade II astrocytomas: an initial experience. Stereotact Funct Neurosurg 79:13–24

    Article  PubMed  Google Scholar 

  30. Wang LW, Shiau CY, Chung WY, Wu HM, Guo WY, Liu KD, Ho DM, Wong TT, Pan DH (2006) Gamma knife surgery for low-grade astrocytomas: evaluation of long-term outcome based on a 10-year experience. J Neurosurg 105(Suppl):127–132

    Google Scholar 

  31. Szeifert GT, Prasad D, Kamyrio T, Steiner M, Steiner LE (2007) The role of the gamma knife in the management of cerebral astrocytomas. Prog Neurol Surg 20:150–163

    Article  PubMed  Google Scholar 

  32. Henderson MA, Fakiris AJ, Timmerman RD, Worth RM, Lo SS, Witt TC (2009) Gamma knife stereotactic radiosurgery for low-grade astrocytomas. Stereotact Funct Neurosurg 87:161–167

    Article  PubMed  Google Scholar 

  33. Kreth FW, Faist M, Rossner R, Volk B, Ostertag CB (1997) Supratentorial World Health Organization Grade 2 astrocytomas and oligoastrocytomas. A new pattern of prognostic factors. Cancer 79:370–379

    Article  PubMed  CAS  Google Scholar 

  34. Plathow C, Schulz-Ertner D, Thilman C, Zuna I, Lichy M, Weber MA, Schlemmer HP, Wannenmacher M, Debus J (2003) Fractionated stereotactic radiotherapy in low-grade astrocytomas: long-term outcome and prognostic factors. Int J Radiat Oncol Biol Phys 57:996–1003

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Kyung-Jae Park, Hideyuki Kano, Douglas Kondziolka, Ajay Niranjan & L. Dade Lunsford

  2. Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea

    Kyung-Jae Park

  3. Department of Radiation Oncology, Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    John C. Flickinger

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  1. Kyung-Jae Park
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  2. Hideyuki Kano
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  3. Douglas Kondziolka
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  4. Ajay Niranjan
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  5. John C. Flickinger
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  6. L. Dade Lunsford
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Correspondence to L. Dade Lunsford.

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Park, KJ., Kano, H., Kondziolka, D. et al. Early or delayed radiosurgery for WHO grade II astrocytomas. J Neurooncol 103, 523–532 (2011). https://doi.org/10.1007/s11060-010-0409-0

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  • DOI: https://doi.org/10.1007/s11060-010-0409-0

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