Wei Zhishuo, Pease Matthew, Tang Lilly W, Deng Hansen, Shanahan Regan, Faramand Andrew, Niranjan Ajay, Lunsford L Dade
Department of Neurological Surgery, UPMC, PA, Pittsburgh, USA.
UPMC Presbyterian, University of Pittsburgh, Suite B-400200 Lothrop Street, Pittsburgh, PA, 15213, USA.
J Neurooncol. 2023 Mar;162(1):157-165. doi: 10.1007/s11060-023-04277-8. Epub 2023 Mar 9.
To assess survival and neurological outcomes for patients who underwent primary or salvage stereotactic radiosurgery (SRS) for infratentorial juvenile pilocytic astrocytomas (JPA).
Between 1987 and 2022, 44 patients underwent SRS for infratentorial JPA. Twelve patients underwent primary SRS and 32 patients underwent salvage SRS. The median patient age at SRS was 11.6 years (range, 2-84 years). Prior to SRS, 32 patients had symptomatic neurological deficits, with ataxia as the most common symptom in 16 patients. The median tumor volume was 3.22 cc (range, 0.16-26.6 cc) and the median margin dose was 14 Gy (range, 9.6-20 Gy).
The median follow-up was 10.9 years (range, 0.42-26.58 years). Overall survival (OS) after SRS was 97.7% at 1-year, and 92.5% at 5- and 10-years. Progression free survival (PFS) after SRS was 95.4% at 1-year, 79.0% at 5-years, and 61.4% at 10-years. There is not a significant difference in PFS between primary and salvage SRS patients (p = 0.79). Younger age correlated with improved PFS (HR 0.28, 95% CI 0.063-1.29, p = 0.021). Sixteen patients (50%) had symptomatic improvements while 4 patients (15.6%) had delayed onset of new symptoms related to tumor progression (n = 2) or treatment related complications (n = 2). Tumor volumetric regression or disappearance after radiosurgery was found in 24 patients (54.4%). Twelve patients (27.3%) had delayed tumor progression after SRS. Additional management of tumor progression included repeat surgery, repeat SRS, and chemotherapy.
SRS was a valuable alternative to initial or repeat resection for deep seated infratentorial JPA patients. We found no survival differences between patients who had primary and salvage SRS.
评估幕下青少年毛细胞型星形细胞瘤（JPA）患者接受初次或挽救性立体定向放射外科治疗（SRS）后的生存情况和神经功能结局。
1987年至2022年期间，44例幕下JPA患者接受了SRS治疗。12例患者接受初次SRS，32例患者接受挽救性SRS。接受SRS时患者的中位年龄为11.6岁（范围2 - 84岁）。在接受SRS之前，32例患者有症状性神经功能缺损，16例患者中最常见的症状为共济失调。肿瘤中位体积为3.22立方厘米（范围0.16 - 26.6立方厘米），中位边缘剂量为14 Gy（范围9.6 - 20 Gy）。
中位随访时间为10.9年（范围0.42 - 26.58年）。SRS后的1年总生存率（OS）为97.7%，5年和10年时分别为92.5%。SRS后的无进展生存率（PFS）1年时为95.4%，5年时为79.0%，10年时为61.4%。初次和挽救性SRS患者的PFS无显著差异（p = 0.79）。年龄较小与PFS改善相关（风险比0.28，95%置信区间0.063 - 1.29，p = 0.021）。16例患者（50%）症状改善，4例患者（15.6%）出现与肿瘤进展相关（n = 2）或治疗相关并发症（n = 2）的新症状延迟发作。放射外科治疗后发现24例患者（54.4%）肿瘤体积缩小或消失。12例患者（27.3%）在SRS后出现肿瘤延迟进展。肿瘤进展的额外处理包括再次手术、再次SRS和化疗。
对于深部幕下JPA患者，SRS是初次或重复切除的一种有价值的替代方法。我们发现初次和挽救性SRS患者之间的生存情况无差异。
