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Villanueva KG, Rea ND, Krieger MD. Novel Surgical and Radiologic Risk Factors for Progression or Recurrence of Pediatric Pilocytic Astrocytoma. Pediatr Neurosurg 2019; 54:375-385. [PMID: 31593969 DOI: 10.1159/000503110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pilocytic astrocytomas (PA) are a common, benign childhood tumor known for their slow growth rates and excellent prognosis. The aim of our study was to characterize patient, tumor, and imaging-related risk factors for recurrence and progression of disease. METHODS We identified 116 patients with PA who underwent surgery at our institution between 2000 and 2015. Data were collected retrospectively from the clinical charts. RESULTS The mean age at resection was 7 ± 5 years (range 0.5-31) and mean follow-up was 6 ± 3 years. Initial resection was complete in 33 patients (29%), subtotal in 78 patients (67%), and biopsy in 5 patients (4%). A total of 45/116 (40%) patients experienced either recurrence or progression after initial resection with a mean time to recurrence or progression of 2.2 years. Bivariate analysis identified subtotal resection, tumor location, age at diagnosis, and imaging features (i.e., T2 invasion, exophytic component, hemorrhage, and solid tumors) as factors significantly associated with recurrence or progression (p < 0.05). Conversely, PAs that were completely resected, predominately cystic, and located in the cerebellum were significantly associated with no recurrence or progression (p < 0.05). Multivariate regression analysis narrowed down 4 robust risk factors: extent of resection, T2 invasion, predominantly solid lesions, and presence of an exophytic component (p < 0.05). CONCLUSION Total surgical removal of PA has been the most important prognostic factor for the clinical course of PA. Our study reveals additional risk factors for the recurrence or progression of disease: tumor invasion, solid composition, and tumors with an exophytic component.
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Affiliation(s)
- Karie G Villanueva
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Nolan D Rea
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA,
| | - Mark D Krieger
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA
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Yust-Katz S, de Groot JF, Liu D, Wu J, Yuan Y, Anderson MD, Conrad CA, Milbourne A, Gilbert MR, Armstrong TS. Pregnancy and glial brain tumors. Neuro Oncol 2014; 16:1289-94. [PMID: 24615863 DOI: 10.1093/neuonc/nou019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Improvements in brain tumor treatments have led to an increase in the number of young women with brain tumors who are now considering pregnancy. The aim of this study is to evaluate the influence of pregnancy on brain tumor biology. METHODS In this institutional review board-approved retrospective study, we searched the institution's database for patients with glial brain tumors who were pregnant at the time of diagnosis or became pregnant during the course of their illness. We identified 34 such patients and reviewed their charts to determine each patient's clinical course and pregnancy outcome. RESULTS Fifteen patients were diagnosed with a primary brain tumor during pregnancy: 3 with glioblastomas, 6 with grade III gliomas, and 6 with grade II gliomas. Pregnancy was terminated in only 2 of these patients, and the remainder delivered healthy babies. Twenty-three patients became pregnant after diagnosis (4 patients were pregnant at diagnosis and again after diagnosis). Of the patients who became pregnant after diagnosis, the 5 with grade I tumors had stable disease during and after pregnancy. However, of the 18 patients with grade II or III gliomas, 8 (44%) had confirmed tumor progression during pregnancy or within 8 weeks of delivery. CONCLUSIONS In contrast to grade I gliomas, the tumor biology of grades II and III gliomas may be altered during pregnancy, leading to an increased risk of tumor progression. These findings support the need for increased tumor surveillance and patient counseling and for additional data collection to further refine these results.
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Affiliation(s)
- Shlomit Yust-Katz
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Diane Liu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Jimin Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Ying Yuan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Mark D Anderson
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Charles A Conrad
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Andrea Milbourne
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Mark R Gilbert
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Terri S Armstrong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
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