Upfront observation versus radiation for adult pilocytic astrocytoma

Adrian Ishkanian, Normand J. Laperriere, Wei Xu, Barbara Ann Millar, David Payne, Warren Mason, Arjun Sahgal

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Although pilocytic astrocytoma accounts for up to 40% of all childhood brain tumors, it is a rare disease in adults. Consequently, there are few mature data on the impact of up-front treatment options after surgery that include observation or adjuvant radiotherapy. Methods: Ten women and 20 men were identified who were diagnosed with pilocytic astrocytoma from 1971 to 2007 and were retrospectively reviewed. The median patient age was 30 years (range, 18-64 years), and the median follow-up was 87 months (range, 16-420 months). Initial surgery included biopsy (10% of patients), subtotal resection (57% of patients), or gross-total resection (33% of patients). Nineteen patients were observed postoperatively, whereas 11 patients received up-front postoperative adjuvant radiotherapy (50 grays in 25 fractions). No patient received adjuvant or concurrent chemotherapy. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Differences between survival curves were analyzed with the log-rank test. Results: For the entire cohort, the 5-year and 10-year OS rates were 95% and 85%, respectively, and the 5-year and 10-year PFS rates were 63% and 35%, respectively. The median PFS was 8.4 years. Initial radiation, compared with observation, did not have an impact on OS but significantly improved PFS. The 5-year PFS rate for patients who were observed versus those who received radiation was 42% versus 91%, respectively; and, at 10 years, the PFS rate was 17% versus 60%, respectively (P =.005). Patients who progressed after observation (11 of 19 patients) received various salvage therapies, resulting in a 2-year PFS rate of 68% compared with 33% for patients who progressed after initial radiation (3 of 11 patients) and were salvaged with either chemotherapy or surgery (P =.1). Conclusions: Adjuvant radiotherapy for pilocytic astrocytoma significantly prolonged PFS at both 5 years and 10 years compared with observation. However, equivalent OS was observed, which reflected the efficacy of salvage therapies.

Original languageEnglish (US)
Pages (from-to)4070-4079
Number of pages10
JournalCancer
Volume117
Issue number17
DOIs
StatePublished - Sep 1 2011
Externally publishedYes

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Astrocytoma
Observation
Radiation
Disease-Free Survival
Survival Rate
Adjuvant Radiotherapy
Salvage Therapy
Survival
Drug Therapy
Rare Diseases
Brain Neoplasms

Keywords

  • adult
  • observation
  • pilocytic astrocytoma
  • radiation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Ishkanian, A., Laperriere, N. J., Xu, W., Millar, B. A., Payne, D., Mason, W., & Sahgal, A. (2011). Upfront observation versus radiation for adult pilocytic astrocytoma. Cancer, 117(17), 4070-4079. https://doi.org/10.1002/cncr.25988

Upfront observation versus radiation for adult pilocytic astrocytoma. / Ishkanian, Adrian; Laperriere, Normand J.; Xu, Wei; Millar, Barbara Ann; Payne, David; Mason, Warren; Sahgal, Arjun.

In: Cancer, Vol. 117, No. 17, 01.09.2011, p. 4070-4079.

Research output: Contribution to journalArticle

Ishkanian, A, Laperriere, NJ, Xu, W, Millar, BA, Payne, D, Mason, W & Sahgal, A 2011, 'Upfront observation versus radiation for adult pilocytic astrocytoma', Cancer, vol. 117, no. 17, pp. 4070-4079. https://doi.org/10.1002/cncr.25988
Ishkanian A, Laperriere NJ, Xu W, Millar BA, Payne D, Mason W et al. Upfront observation versus radiation for adult pilocytic astrocytoma. Cancer. 2011 Sep 1;117(17):4070-4079. https://doi.org/10.1002/cncr.25988
Ishkanian, Adrian ; Laperriere, Normand J. ; Xu, Wei ; Millar, Barbara Ann ; Payne, David ; Mason, Warren ; Sahgal, Arjun. / Upfront observation versus radiation for adult pilocytic astrocytoma. In: Cancer. 2011 ; Vol. 117, No. 17. pp. 4070-4079.
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abstract = "Background: Although pilocytic astrocytoma accounts for up to 40{\%} of all childhood brain tumors, it is a rare disease in adults. Consequently, there are few mature data on the impact of up-front treatment options after surgery that include observation or adjuvant radiotherapy. Methods: Ten women and 20 men were identified who were diagnosed with pilocytic astrocytoma from 1971 to 2007 and were retrospectively reviewed. The median patient age was 30 years (range, 18-64 years), and the median follow-up was 87 months (range, 16-420 months). Initial surgery included biopsy (10{\%} of patients), subtotal resection (57{\%} of patients), or gross-total resection (33{\%} of patients). Nineteen patients were observed postoperatively, whereas 11 patients received up-front postoperative adjuvant radiotherapy (50 grays in 25 fractions). No patient received adjuvant or concurrent chemotherapy. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Differences between survival curves were analyzed with the log-rank test. Results: For the entire cohort, the 5-year and 10-year OS rates were 95{\%} and 85{\%}, respectively, and the 5-year and 10-year PFS rates were 63{\%} and 35{\%}, respectively. The median PFS was 8.4 years. Initial radiation, compared with observation, did not have an impact on OS but significantly improved PFS. The 5-year PFS rate for patients who were observed versus those who received radiation was 42{\%} versus 91{\%}, respectively; and, at 10 years, the PFS rate was 17{\%} versus 60{\%}, respectively (P =.005). Patients who progressed after observation (11 of 19 patients) received various salvage therapies, resulting in a 2-year PFS rate of 68{\%} compared with 33{\%} for patients who progressed after initial radiation (3 of 11 patients) and were salvaged with either chemotherapy or surgery (P =.1). Conclusions: Adjuvant radiotherapy for pilocytic astrocytoma significantly prolonged PFS at both 5 years and 10 years compared with observation. However, equivalent OS was observed, which reflected the efficacy of salvage therapies.",
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