Clinical outcome and prognostic factors for central neurocytoma: twenty year institutional experience

Central neurocytomas are uncommon intraventricular neoplasms whose optimal management remains controversial due to their rarity. We assessed outcomes for a historical cohort of neurocytoma patients and evaluated effects of tumor atypia, size, resection extent, and adjuvant radiotherapy. Progression-...

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Published in:Journal of neuro-oncology 2016-01, Vol.126 (1), p.193-200
Main Authors: Imber, Brandon S., Braunstein, Steve E., Wu, Fred Y., Nabavizadeh, Nima, Boehling, Nicholas, Weinberg, Vivian K., Tihan, Tarik, Barnes, Michael, Mueller, Sabine, Butowski, Nicholas A., Clarke, Jennifer L., Chang, Susan M., McDermott, Michael M., Prados, Michael D., Berger, Mitchel S., Haas-Kogan, Daphne A.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Brain Neoplasms - diagnosis
Brain Neoplasms - therapy
Cancer Care Facilities - statistics & numerical data
Child
Child, Preschool
Clinical outcomes
Clinical Study
Cohort Studies
Disease Progression
Female
Humans
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Neurocytoma - diagnosis
Neurocytoma - therapy
Neurology
Oncology
Prognosis
Treatment Outcome
Young Adult
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Summary:Central neurocytomas are uncommon intraventricular neoplasms whose optimal management remains controversial due to their rarity. We assessed outcomes for a historical cohort of neurocytoma patients and evaluated effects of tumor atypia, size, resection extent, and adjuvant radiotherapy. Progression-free survival (PFS) was measured by Kaplan–Meier and Cox proportional hazards methods. A total of 28 patients (15 males, 13 females) were treated between 1995 and 2014, with a median age at diagnosis of 26 years (range 5–61). Median follow-up was 62.2 months and 3 patients were lost to follow-up postoperatively. Thirteen patients experienced recurrent/progressive disease and 2-year PFS was 75 % (95 % CI 53–88 %). Two-year PFS was 48 % for MIB-1 labeling >4 % versus 90 % for ≤4 % (HR 5.4, CI 2.2–27.8, p  = 0.0026). Nine patients (32 %) had gross total resections (GTR) and 19 (68 %) had subtotal resections (STR). PFS for >80 % resection was 83 versus 67 % for ≤80 % resection (HR 0.67, CI 0.23–2.0, p  = 0.47). Three STR patients (16 %) received adjuvant radiation which significantly improved overall PFS ( p  = 0.049). Estimated 5-year PFS was 67 % for STR with radiotherapy versus 53 % for STR without radiotherapy. Salvage therapy regimens were diverse and resulted in stable disease for 54 % of patients and additional progression for 38 %. Two patients with neuropathology-confirmed atypical neurocytomas died at 4.3 and 113.4 months after initial surgery. For central neurocytomas, MIB-1 labeling index >4 % is predictive of poorer outcome and our data suggest that adjuvant radiotherapy after STR may improve PFS. Most patients requiring salvage therapy will be stabilized and multiple modalities can be effectively utilized.
ISSN:0167-594X
1573-7373
DOI:10.1007/s11060-015-1959-y