Recurrent astroblastoma treated with gamma knife radiosurgery
Department of Neurological Surgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA.Journal of Neuro-Oncology (Impact Factor: 3.07). 10/2010; 103(3):751-4. DOI: 10.1007/s11060-010-0430-3
Astroblastomas are exceedingly rare central nervous system tumors. Surgical resection is the standard initial treatment for astroblastomas. Still, some astroblastomas that have been completely resected recur. The optimal treatment for these lesions is unclear. There are no previous reports of the use of Gamma Knife radiosurgery in the treatment of astroblastomas. The patient is a 58 year old woman who had undergone resection of a left parieto-occipital tumor at an outside hospital in 2002, with repeat resection for recurrences in 2005 and 2007. Pathologic analysis at the Mayo Clinic demonstrated the tumor to be a low-grade astroblastoma. Repeat imaging in 2008 again demonstrated recurrence, and the patient was referred to our center for Gamma Knife radiosurgery. Pre and post-contrast T1 stereotactic MR images were obtained and imported into the treatment planning system for the Gamma Knife Perfexion. Two foci of tumor consistent with the patient's known left parietal astroblastoma were identified. A prescription dose of 18.00 Gy to the 50% isodose was delivered, and 16 isocenters were used. Follow-up imaging 17 months post-radiosurgery demonstrated a decrease in tumor size. Gamma Knife radiosurgery represents a useful treatment modality for recurrent astroblastomas. While surgical resection of low grade astroblastomas can be curative, Gamma Knife radiosurgery may be beneficial in cases where gross total resection is not feasible.
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- "The possible theory behind the development of the malignant astroblastoma could be due to cerebrospinal fluid (CSF) seeding. However, it is was only reported once in the literature. Another point against CSF seeding are the malignant features that the second tumor displayed. The theory of transformation is not possible in this case since the second malignant focus had a different location and was growing rapidly. "
ABSTRACT: Astroblastoma is a rare brain tumor occurring in children and adults, rarely in the elderly. It constitutes up to 3% of all brain tumors. We report a case of a 14-year-old girl who presented with recurrent seizures and minimal right hemiparesis. Magnetic resonance imaging (MRI) revealed a left fronto-parietal brain tumor. It was managed with subtotal resection in a local hospital. Subsequently, she was referred to Princess Nora Oncology Center for further characterization and management. Pathology slide revision revealed well-differentiated astroblastoma. Upon follow up, the patient had multiple recurrences of the same tumor and emergence of a new lesion at the area of Sylvian fissure. Excision of the emerging tumor revealed anaplastic astroblastoma. Astroblastoma is a glial tumor that predominantly affects females. Its clinical progression is unpredictable, with high recurrence rate. Surgical intervention is considered the mainstay of treatment, while radiotherapy and chemotherapy effectiveness is debatable. To our knowledge, this is the first reported case of well-differentiated and anaplastic astroblastoma as two separate neoplastic lesions in the same patient with its clinical, radiological, and pathological features.
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ABSTRACT: To report patient characteristics, risk factors, and trends in management for astroblastoma patients. A retrospective analysis was conducted utilizing the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute. Two hundred and thirty nine patients were identified with 206 patients receiving treatment. The median age at diagnosis was 35 years (range 0-84 years). Tumor location was available for 177 patients, and the majority were supratentorial (n= 144, 81.3%). The median overall survival and cause specific survival for the cohort receiving treatment was 55 and 65 months, respectively. On univariate analysis, patients receiving surgery alone compared to solely radiotherapy displayed improved overall survival (OS) and cause specific survival (CSS) with a 5 year OS of 62.2% versus 27.3% p<0.001 and CSS of 67.3% vs. 31.9% p=0.003. Supratentorial tumor location was associated with worse survival with an estimated 5 year OS of 44.9% for supratentorial tumors compared to 75% for infratentorial tumors (HR 3.41 [1.76-6.62]; p<.001) and CSS of 47.5% (supratentorial) to 82% (infratentorial) (HR 3.95 [1.81-8.62]; p=0.001). Age > 60 yrs at diagnosis and treatment before 1990 were correlated with decreased survival on both the univariate and multivariate analyses. To our knowledge, this is the largest report of astroblastoma patients described in the literature. Supratentorial tumor location, older age, and treatment prior to 1990 were poor prognostic factors.
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ABSTRACT: Astroblastoma is a rare, mostly supratentorial glial tumor, occurring predominantly in children and young adults with female preponderance. Due to the rarity, with only about 230 reported cases, treatment strategies are still to be discussed. We describe two more cases to add to the clinical experiences with this tumor entity. In both of these cases, the clinical behavior did not follow the expectations based on histopathological classification. Case 1: A sixteen-year old female presented with a six month history of intermittent headaches, nausea and dizziness. MRI scans revealed a left parietooccipital mass lesion with bubbly contrast enhancement and marked peritumoral edema. After gross total tumor resection the histology gave the diagnosis of low grade astroblastoma. Fifteen months later, the patient was operated on a local recurrence and received postoperative radiotherapy, with the histology still being that of low grade astroblastoma. Two years later, a meningeally based tumor nodule frontal of the former tumor bed was removed, now diagnosed as high grade astroblastoma. Eighteen months later, a fourth operation with excision of two more meningeally based tumor nodules of high-grade astroblastoma followed. Chemotherapy was suggested, but the patient decided against it. The last MRI follow-up 14 months after last operation showed no further recurrence so far. Case 2: A 24-year old female presented with a four week history of vomiting and headaches with focal seizures affecting her left arm. CT and MRI scans revealed a superficial partly cystic right temporal mass lesion with few edema and macrocalcifications and adjacent bone atrophy. Despite dural invasion, total tumor resection could be performed. MRI scans six months later showed no recurrence. The patient refused further MRI controls but did not show any clinical signs or symptoms suggesting tumor recurrence four years after the operation. In order to find more predictive tools that might help to determine the individual clinical course and treatment, we performed a review of the literature, analyzing 29 cases with detailed data on clinical history, MRI/CT characteristics, histopathological subtyping, treatment details and a follow-up of at least 12 months. We found, that low-grade astroblastoma with marked peritumoral edema has a tendency to early recurrence and suggest that it should be treated by combined surgery and radiotherapy. In high-grade astroblastoma with well defined tumor borders and few peritumoral edema, the prognosis may be better than expected for a high-grade glioma, if GTR is possible.
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