Twenty-three Years Follow-up After Low-dose Gamma Knife Surgery of a Brainstem Juvenile Pilocytic Astrocytoma: a Case Report and Review of the Literature

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2019 Apr 19

PMID 30997566

Citations 3

Authors

J Sherry Liu

Denise Foo

Tseng Tsai Yeo

Kee Hang Ho

Vincent Diong Weng Nga

Bengt Karlsson

Affiliations

Soon will be listed here.

Abstract

Juvenile pilocytic astrocytoma (JPA) is a World Health Organization (WHO) grade I tumor that is the commonest to occur in the 0-19 age group, with an excellent prognosis of 96% 10-year survival in pediatric patients. Complete resection is the treatment of choice for JPAs. However, this is not always feasible due to the location of certain tumors, and the management following subtotal resection is controversial. Fractionated radiotherapy, chemotherapy, radiosurgery, and observation have all been used to treat tumor remnants. We report a young patient with good tumor control 23 years following low-dose Gamma Knife surgery (GKS) of a subtotally resected brainstem JPA and recommend that GKS may be a feasible treatment option to achieve long-term tumor control when subtotal resection cannot be achieved, even if the GKS prescription dose must be significantly reduced due to large tumor volume or proximity to critical structures sensitive to radiation.

Citing Articles

Gamma Knife Radiosurgery for symptomatic eloquently deep-seated cystic pilocytic astrocytoma mural nodules: Retrospective case series of effective outcomes.

Hafez R, Fahmy O, Hassan H, Ganz J Acta Neurochir (Wien). 2024; 166(1):466.

PMID: 39565484 DOI: 10.1007/s00701-024-06366-7.

Efficacy of surgery for the treatment of astrocytoma: A protocol of systematic review and meta-analysis.

Wang G, Li B Medicine (Baltimore). 2020; 99(23):e20485.

PMID: 32501995 PMC: 7306387. DOI: 10.1097/MD.0000000000020485.

Clinical significance of CD133 and Nestin in astrocytic tumor: The correlation with pathological grade and survival.

Zhang Q, Xu B, Chen J, Chen F, Chen Z J Clin Lab Anal. 2019; 34(3):e23082.

PMID: 31677196 PMC: 7083417. DOI: 10.1002/jcla.23082.

References

Kida Y, Kobayashi T, Mori Y . Gamma knife radiosurgery for low-grade astrocytomas: results of long-term follow up. J Neurosurg. 2001; 93 Suppl 3:42-6. DOI: 10.3171/jns.2000.93.supplement. View

Ulfarsson E, Lindquist C, Roberts M, Rahn T, Lindquist M, Thoren M . Gamma knife radiosurgery for craniopharyngiomas: long-term results in the first Swedish patients. J Neurosurg. 2003; 97(5 Suppl):613-22. DOI: 10.3171/jns.2002.97.supplement. View

Boethius J, Ulfarsson E, Rahn T, Lippittz B . Gamma knife radiosurgery for pilocytic astrocytomas. J Neurosurg. 2003; 97(5 Suppl):677-80. DOI: 10.3171/jns.2002.97.supplement. View

Palma L, Celli P, Mariottini A . Long-term follow-up of childhood cerebellar astrocytomas after incomplete resection with particular reference to arrested growth or spontaneous tumour regression. Acta Neurochir (Wien). 2004; 146(6):581-8. DOI: 10.1007/s00701-004-0257-9. View

Ohgaki H, Kleihues P . Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol. 2005; 64(6):479-89. DOI: 10.1093/jnen/64.6.479. View

Gunny R, Hayward R, Phipps K, Harding B, Saunders D . Spontaneous regression of residual low-grade cerebellar pilocytic astrocytomas in children. Pediatr Radiol. 2005; 35(11):1086-91. DOI: 10.1007/s00247-005-1546-z. View

Steinbok P, Poskitt K, Hendson G . Spontaneous regression of cerebellar astrocytoma after subtotal resection. Childs Nerv Syst. 2006; 22(6):572-6. DOI: 10.1007/s00381-006-0058-y. View

Hafez R . Stereotaxic gamma knife surgery in treatment of critically located pilocytic astrocytoma: preliminary result. World J Surg Oncol. 2007; 5:39. PMC: 1852107. DOI: 10.1186/1477-7819-5-39. View

Rozen W, Joseph S, Lo P . Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis. Pediatr Neurosurg. 2008; 44(4):324-8. DOI: 10.1159/000134925. View

10.

Kano H, Niranjan A, Kondziolka D, Flickinger J, Pollack I, Jakacki R . Stereotactic radiosurgery for pilocytic astrocytomas part 2: outcomes in pediatric patients. J Neurooncol. 2009; 95(2):219-229. DOI: 10.1007/s11060-009-9912-6. View

11.

Foroughi M, Hendson G, Sargent M, Steinbok P . Spontaneous regression of septum pellucidum/forniceal pilocytic astrocytomas--possible role of Cannabis inhalation. Childs Nerv Syst. 2011; 27(4):671-9. DOI: 10.1007/s00381-011-1410-4. View

12.

Ogiwara H, Bowman R, Tomita T . Long-term follow-up of pediatric benign cerebellar astrocytomas. Neurosurgery. 2011; 70(1):40-7. DOI: 10.1227/NEU.0b013e31822ff0ed. View

13.

Lizarraga K, Gorgulho A, Lee S, Rauscher G, Selch M, DeSalles A . Stereotactic radiation therapy for progressive residual pilocytic astrocytomas. J Neurooncol. 2012; 109(1):129-35. DOI: 10.1007/s11060-012-0877-5. View

14.

Gnekow A, Falkenstein F, von Hornstein S, Zwiener I, Berkefeld S, Bison B . Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German Speaking Society of Pediatric Oncology and Hematology. Neuro Oncol. 2012; 14(10):1265-84. PMC: 3452343. DOI: 10.1093/neuonc/nos202. View

15.

Loh J, Lieu A, Chai C, Hwang S, Kwan A, Wang C . Arrested growth and spontaneous tumor regression of partially resected low-grade cerebellar astrocytomas in children. Childs Nerv Syst. 2013; 29(11):2051-5. PMC: 3825417. DOI: 10.1007/s00381-013-2113-9. View

16.

Ostrom Q, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C . CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol. 2015; 17 Suppl 4:iv1-iv62. PMC: 4623240. DOI: 10.1093/neuonc/nov189. View

17.

Buder T, Deutsch A, Klink B, Voss-Bohme A . Model-Based Evaluation of Spontaneous Tumor Regression in Pilocytic Astrocytoma. PLoS Comput Biol. 2015; 11(12):e1004662. PMC: 4675550. DOI: 10.1371/journal.pcbi.1004662. View

18.

Simonova G, Kozubikova P, Liscak R, Novotny Jr J . Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results. J Neurosurg Pediatr. 2016; 18(1):58-64. DOI: 10.3171/2015.10.PEDS14443. View

19.

Trifiletti D, Peach M, Xu Z, Kersh R, Showalter T, Sheehan J . Evaluation of outcomes after stereotactic radiosurgery for pilocytic astrocytoma. J Neurooncol. 2017; 134(2):297-302. DOI: 10.1007/s11060-017-2521-x. View

20.

Kihlstrom L, Lindquist C, Lindquist M, Karlsson B . Stereotactic radiosurgery for tectal low-grade gliomas. Acta Neurochir Suppl. 1994; 62:55-7. DOI: 10.1007/978-3-7091-9371-6_11. View