Adult pilocytic astrocytoma: clinical management and prognostic factors.

158 Objective: The purpose of this study is to analyze adult patients with pilocytic astrocytomas and to identify factors associated with recurrence and survival. Background: Pilocytic astrocytomas (WHO grade I) represent the most common central nervous system tumor in the pediatric population, but is rare in the adult population. Given the rarity of this tumor in the adult population, we sought to understand the clinical behavior of adult pilocytic astrocytoma (PA) patients retrospectively. Design/Methods: Patients at the Preston Robert Tisch Brain Tumor Center at Duke were consented as part of a database registry between 12/31/2004 and 10/12/2016. All cases of adult PA (patients ≥ 18 years of age at time of diagnosis) were identified and data were evaluated retrospectively for demographic information, absence or presence of tumor progression, treatment, and survival outcomes. We estimated progression-free survival and overall survival using Kaplan-Meier methods. Results: There were 42 patients with adult PA identified (age 19–76 yrs, mean = 31.65, sd= 12.26). Of the 42 patients, 20 (47.6%) had tumor progression and 8 (21.4%) passed away. 7 of 8 patients (87.5%) that died experienced tumor progression. Tumor progression was seen in 7 of the 22 (31.8%) patients with gross total resection (GTR), 9 of the 13 (69.2%) patients with subtotal resection (STR), and 4 of the 7 (57.1%) patients with biopsy. Death was seen in 2 of the 22 (9.1%) patients with GTR, compared to 6 of the 20 (30.0%) patients with STR or biopsy. Progression-free 10-year survival was 45% (95% CI: 26.2%, 62.1%) and 10-year overall survival was 79.6% (95% CI: 61.8%, 89.8%). Conclusions: For adults with PA, 10-year progression-free survival was approximately 45%, which emphasizes the importance of long term monitoring. The number of progressions and deaths amongst adult PA patients receiving GTR was less than that among those receiving STR or biopsy.

Duke Scholars

Author John P. Kirkpatrick Radiation Oncology

Author David Michael Ashley Neurosurgery

Author Henry Seth Friedman Neurosurgery, Neuro-Oncology

Author Katherine Barnett Peters Neurosurgery, Neuro-Oncology