Kevin J Lee1, Eduardo Marchan1, Jennifer Peterson2, Anna C Harrell1, Alfredo Quinones-Hinojosa3, Paul D Brown4, Daniel M Trifiletti5. 1. Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA. 2. Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA. 3. Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA. 4. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA. 5. Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA. Electronic address: trifiletti.daniel@mayo.edu.
Abstract
BACKGROUND: Adult pilocytic astrocytomas (PAs) are relatively rare central nervous system (CNS) tumors with a favorable prognosis. We sought to investigate existing clinical management strategies and overall survival (OS) as a function of various clinical characteristics in a cohort of adult patients with PA. METHODS: The study cohort comprised all patients age >18 years diagnosed with a CNS PA diagnosed between 2004 and 2014 and included in the National Cancer Database. Clinical and treatment-related characteristics were recorded and analyzed for associations with OS following diagnosis using univariate and multivariate analyses. RESULTS: A total of 3057 adult patients, with a median age of 32 years, met the inclusion criteria. At diagnosis, 1138 patients (41%) had cerebral tumors, 832 (30%) had cerebellar tumors, 252 (9%) had tumors of the spinal cord, and 534 (19%) had tumors of unspecified location. More than three-quarters (77%) of the patients underwent surgery alone as local therapy, with the remainder split among surgery plus radiation (11.9%), radiation alone (4.5%), and biopsy alone (6.9%). On multivariate analysis, factors associated with inferior OS included older age (hazard ratio [HR], 1.05; P < 0.001), lower income (P < 0.001), higher Charlson/Deyo score (P = 0.023), larger tumor size (P = 0.023), and radiation therapy technique (P < 0.001; HR, 3.37 for external beam radiation therapy [EBRT]). CONCLUSIONS: Our data provide large-scale prognostic information from a contemporary cohort of patients with PA, confirming that age, median income, Charlson/Deyo Score, and tumor size have significant effects on OS. Although resection status, tumor size, and location likely bias against EBRT, novel therapeutics are clearly needed in patients with tumors not amenable to resection or radiosurgery.
BACKGROUND: Adult pilocytic astrocytomas (PAs) are relatively rare central nervous system (CNS) tumors with a favorable prognosis. We sought to investigate existing clinical management strategies and overall survival (OS) as a function of various clinical characteristics in a cohort of adult patients with PA. METHODS: The study cohort comprised all patients age >18 years diagnosed with a CNS PA diagnosed between 2004 and 2014 and included in the National Cancer Database. Clinical and treatment-related characteristics were recorded and analyzed for associations with OS following diagnosis using univariate and multivariate analyses. RESULTS: A total of 3057 adult patients, with a median age of 32 years, met the inclusion criteria. At diagnosis, 1138 patients (41%) had cerebral tumors, 832 (30%) had cerebellar tumors, 252 (9%) had tumors of the spinal cord, and 534 (19%) had tumors of unspecified location. More than three-quarters (77%) of the patients underwent surgery alone as local therapy, with the remainder split among surgery plus radiation (11.9%), radiation alone (4.5%), and biopsy alone (6.9%). On multivariate analysis, factors associated with inferior OS included older age (hazard ratio [HR], 1.05; P < 0.001), lower income (P < 0.001), higher Charlson/Deyo score (P = 0.023), larger tumor size (P = 0.023), and radiation therapy technique (P < 0.001; HR, 3.37 for external beam radiation therapy [EBRT]). CONCLUSIONS: Our data provide large-scale prognostic information from a contemporary cohort of patients with PA, confirming that age, median income, Charlson/Deyo Score, and tumor size have significant effects on OS. Although resection status, tumor size, and location likely bias against EBRT, novel therapeutics are clearly needed in patients with tumors not amenable to resection or radiosurgery.
Authors: Matthew W Parsons; Nicholas S Whipple; Matthew M Poppe; Joe S Mendez; Donald M Cannon; Lindsay M Burt Journal: J Neurooncol Date: 2020-10-31 Impact factor: 4.130
Authors: Omer Sager; Ferrat Dincoglan; Selcuk Demiral; Bora Uysal; Hakan Gamsiz; Esra Gumustepe; Fatih Ozcan; Onurhan Colak; Ahmet Tarik Gursoy; Cemal Ugur Dursun; Ahmet Oguz Tugcu; Galip Dogukan Dogru; Rukiyye Arslan; Yelda Elcim; Esin Gundem; Bahar Dirican; Murat Beyzadeoglu Journal: World J Exp Med Date: 2022-05-20
Authors: Devin McBride; Zaid Aljuboori; Eyas M Hattab; Richard Downs; Shiao Woo; Brian Williams; Joseph Neimat; Eric Burton Journal: BMC Cancer Date: 2018-08-09 Impact factor: 4.430
Authors: Khadeja Khan; Evan Luther; Alexis A Morrell; Sze Kiat Tan; Daniel G Eichberg; Ashish H Shah; Victor M Lu; Sakir H Gultekin; Jacques J Morcos Journal: Surg Neurol Int Date: 2021-07-19