The Role of Radiosurgery for the Treatment of Pineal Parenchymal Tumors

Author:

Hasegawa Toshinori1,Kondziolka Douglas2,Hadjipanayis Constantinos G.1,Flickinger John C.2,Lunsford L. Dade3

Affiliation:

1. Department of Neurological Surgery, University of Pittsburgh School of Medicine, and Center for Image-Guided Neurosurgery, Pittsburgh, Pennsylvania

2. Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, and Center for Image-Guided Neurosurgery, Pittsburgh, Pennsylvania

3. Departments of Neurological Surgery, Radiation Oncology, and Radiology, University of Pittsburgh School of Medicine, and Center for Image-Guided Neurosurgery, Pittsburgh, Pennsylvania

Abstract

Abstract OBJECTIVE Radiosurgery is an appealing alternative management strategy for selected patients with biopsy-proved pineal parenchymal tumors. The purpose of this report was to clarify its role in conjunction with other surgical, radiation, and medical approaches. METHODS We retrospectively evaluated 16 patients who had undergone radiosurgery as the primary or adjuvant treatment for pineal parenchymal tumors. Ten patients (62.5%) had pineocytomas, two (12.5%) had mixed pineocytoma and pineoblastoma, and four (25%) had pineoblastomas. The mean marginal dose was 15 Gy, and the mean tumor volume was 5.0 cm3. The mean follow-up periods from the time of diagnosis or the time of radiosurgery were 61 and 52 months, respectively. RESULTS The overall actuarial 2- and 5-year survival rates after diagnosis were 75.0 and 66.7%, respectively. In 14 patients who were evaluated with imaging, 4 (29%) demonstrated complete remission, 8 (57%) had partial remission, 2 (14%) had no change, and no patient had local progression. The local tumor control rate (complete remission, partial remission, or no change) was 100%. Five patients died during follow-up. One patient with a pineocytoma and three patients with pineoblastomas died secondary to leptomeningeal or extracranial spread tumor. No cause of death was established for one patient. Two patients developed adverse radiation effects after radiosurgery. CONCLUSION Our initial experience suggests that stereotactic radiosurgery is a valuable primary management modality for patients with pineocytomas. As adjuvant therapy, radiosurgery may be used to boost local tumor dose during multimodality management of malignant pineal parenchymal tumors.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

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5. Pineal tumors: Experience with 48 cases over 10 years;Cho;Childs Nerv Syst,1998

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