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Stereotactic radiosurgery for central neurocytomas: an international multicenter retrospective cohort study

YC. Hung, CC. Lee, HC. Yang, N. Mohammed, KN. Kearns, SB. Sun, D. Mathieu, CJ. Touchette, AF. Atik, IS. Grills, B. Squires, D. Ding, BJ. Williams, MB. Yusuf, SY. Woo, R. Liscak, J. Hanuska, JC. Shiao, D. Kondziolka, LD. Lunsford, Z. Xu, JP. Sheehan

. 2020 ; 134 (3) : 1122-1131. [pub] 20200403

Language English Country United States

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc21026730

OBJECTIVE: Central neurocytomas (CNs) are uncommon intraventricular tumors, and their rarity renders the risk-to-benefit profile of stereotactic radiosurgery (SRS) unknown. The aim of this multicenter, retrospective cohort study was to evaluate the outcomes of SRS for CNs and identify predictive factors. METHODS: The authors retrospectively analyzed a cohort of patients with CNs treated with SRS at 10 centers between 1994 and 2018. Tumor recurrences were classified as local or distant. Adverse radiation effects (AREs) and the need for a CSF shunt were also evaluated. RESULTS: The study cohort comprised 60 patients (median age 30 years), 92% of whom had undergone prior resection or biopsy and 8% received their diagnosis based on imaging alone. The median tumor volume and margin dose were 5.9 cm3 and 13 Gy, respectively. After a median clinical follow-up of 61 months, post-SRS tumor recurrence occurred in 8 patients (13%). The 5- and 10-year local tumor control rates were 93% and 87%, respectively. The 5- and 10-year progression-free survival rates were 89% and 80%, respectively. AREs were observed in 4 patients (7%), but only 1 was symptomatic (2%). Two patients underwent post-SRS tumor resection (3%). Prior radiotherapy was a predictor of distant tumor recurrence (p = 0.044). Larger tumor volume was associated with pre-SRS shunt surgery (p = 0.022). CONCLUSIONS: Treatment of appropriately selected CNs with SRS achieves good tumor control rates with a reasonable complication profile. Distant tumor recurrence and dissemination were observed in a small proportion of patients, which underscores the importance of close post-SRS surveillance of CN patients. Patients with larger CNs are more likely to require shunt surgery before SRS.

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$a Hung, Yi-Chieh $u 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia $u 2Department of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan $u 3Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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$a Stereotactic radiosurgery for central neurocytomas: an international multicenter retrospective cohort study / $c YC. Hung, CC. Lee, HC. Yang, N. Mohammed, KN. Kearns, SB. Sun, D. Mathieu, CJ. Touchette, AF. Atik, IS. Grills, B. Squires, D. Ding, BJ. Williams, MB. Yusuf, SY. Woo, R. Liscak, J. Hanuska, JC. Shiao, D. Kondziolka, LD. Lunsford, Z. Xu, JP. Sheehan
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$a OBJECTIVE: Central neurocytomas (CNs) are uncommon intraventricular tumors, and their rarity renders the risk-to-benefit profile of stereotactic radiosurgery (SRS) unknown. The aim of this multicenter, retrospective cohort study was to evaluate the outcomes of SRS for CNs and identify predictive factors. METHODS: The authors retrospectively analyzed a cohort of patients with CNs treated with SRS at 10 centers between 1994 and 2018. Tumor recurrences were classified as local or distant. Adverse radiation effects (AREs) and the need for a CSF shunt were also evaluated. RESULTS: The study cohort comprised 60 patients (median age 30 years), 92% of whom had undergone prior resection or biopsy and 8% received their diagnosis based on imaging alone. The median tumor volume and margin dose were 5.9 cm3 and 13 Gy, respectively. After a median clinical follow-up of 61 months, post-SRS tumor recurrence occurred in 8 patients (13%). The 5- and 10-year local tumor control rates were 93% and 87%, respectively. The 5- and 10-year progression-free survival rates were 89% and 80%, respectively. AREs were observed in 4 patients (7%), but only 1 was symptomatic (2%). Two patients underwent post-SRS tumor resection (3%). Prior radiotherapy was a predictor of distant tumor recurrence (p = 0.044). Larger tumor volume was associated with pre-SRS shunt surgery (p = 0.022). CONCLUSIONS: Treatment of appropriately selected CNs with SRS achieves good tumor control rates with a reasonable complication profile. Distant tumor recurrence and dissemination were observed in a small proportion of patients, which underscores the importance of close post-SRS surveillance of CN patients. Patients with larger CNs are more likely to require shunt surgery before SRS.
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$a Lee, Cheng-Chia $u 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan $u 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
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$a Yang, Huai-Che $u 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan $u 5School of Medicine, National Yang-Ming University, Taipei, Taiwan
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$a Mohammed, Nasser $u 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Kearns, Kathryn N $u 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Sun, Shi-Bin $u 6Gamma Knife Center, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, China
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$a Mathieu, David $u 7Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
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$a Touchette, Charles J $u 7Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
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$a Atik, Ahmet F $u 8Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
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$a Grills, Inga S $u 9Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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$a Squires, Bryan $u 9Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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$a Ding, Dale $u Departments of10Neurosurgery and
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$a Williams, Brian J $u Departments of10Neurosurgery and
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$a Yusuf, Mehran B $u 11Radiation Oncology, University of Louisville, Kentucky
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$a Woo, Shiao Y $u 11Radiation Oncology, University of Louisville, Kentucky
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$a Liscak, Roman $u 12Departments of Stereotactic and Radiation Neurosurgery and
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$a Hanuska, Jaromir $u 13Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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$a Shiao, Jay C $u 14Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
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$a Kondziolka, Douglas $u 15Department of Neurosurgery, NYU Langone Health System, New York, New York; and
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$a Lunsford, L Dade $u 16Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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$a Xu, Zhiyuan $u 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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$a Sheehan, Jason P $u 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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