BACKGROUND AND OBJECTIVES: Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial tumor primarily affecting young individuals. Surgery is the primary treatment option; however, managing residual/recurrent tumors remains uncertain. This international multi-institutional study retrospectively assessed the use of stereotactic radiosurgery (SRS) for PXA. METHODS: A total of 36 PXA patients (53 tumors) treated at 11 institutions between 1996 and 2023 were analyzed. Data included demographics, clinical variables, SRS parameters, tumor control, and clinical outcomes. Kaplan-Meier estimates summarized the local control (LC), progression-free survival, and overall survival (OS). Secondary end points addressed adverse radiation effects and the risk of malignant transformation. Cox regression analysis was used. RESULTS: A total of 38 tumors were grade 2, and 15 tumors were grade 3. Nine patients underwent initial gross total resection, and 10 received adjuvant therapy. The main reason for SRS was residual tumors (41.5%). The median follow-up was 34 months (range, 2-324 months). LC was achieved in 77.4% of tumors, with 6-month, 1-year, and 2-year LC estimates at 86.7%, 82.3%, and 77.8%, respectively. Younger age at SRS (hazard ratios [HR] 3.164), absence of peritumoral edema (HR 4.685), and higher marginal dose (HR 6.190) were significantly associated with better LC. OS estimates at 1, 2, and 5 years were 86%, 74%, and 49.3%, respectively, with a median OS of 44 months. Four patients died due to disease progression. Radiological adverse radiation effects included edema (n = 8) and hemorrhagic change (n = 1). One grade 3 PXA transformed into glioblastoma 13 months after SRS. CONCLUSION: SRS offers promising outcomes for PXA management, providing effective LC, reasonable progression-free survival, and minimal adverse events.

Department of Clinical Oncology Ain Shams University Cairo Egypt

Department of Neurological Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA

Department of Neurological Surgery University of Virginia Charlottesville Virginia USA

Department of Neurosurgery Ain Shams University Cairo Egypt

Department of Neurosurgery Allegheny Health Network Cancer Institute Pittsburgh Pennsylvania USA

Department of Neurosurgery Benha University Benha Egypt

Department of Neurosurgery Gamma Knife Center Koc University Hospital Istanbul Turkey

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Neurosurgery Université de Sherbrooke Centre de recherche du CHUS Sherbrooke Quebec Canada

Department of Radiation Oncology Allegheny Health Network Cancer Institute Pittsburgh Pennsylvania USA

Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt

Department of Radiation Oncology The James Cancer Center Ohio State University Columbus Ohio USA

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt

Radiosurgery Unit Hospital Ruber Internacional Madrid Spain

Vivian L Smith Department of Neurosurgery University of Texas Health Science Center at Houston Houston Texas USA

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