title: Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination.
abstract: OBJECTIVE
  To determine the patient, tumor, and treatment characteristics of patients with pilocytic astrocytoma (PA) and leptomeningeal dissemination (LMD).
  
  
  METHODS
  A PubMed search of English-language studies pertaining to PA with LMD was performed using a combination of keywords that included juvenile pilocytic astrocytoma, low-grade astrocytoma, low-grade glioma, leptomeningeal dissemination, neuraxis spread, and radiotherapy. We found 26 studies with 58 patients between 1976 and 2005 that met these criteria.
  
  
  RESULTS
  The median survival for PA patients with LMD was 65 months. The 1-, 2-, and 5-year overall survival (OS) rate after the diagnosis of LMD was 81.1%, 75.7%, and 55.5%. The 1-, 2-, and 5-year progression-free survival (PFS) rate after the diagnosis of LMD was 69.3%, 66.5%, and 34.6%, respectively. Age, gender, primary site location, timing of LMD presentation (synchronous vs. metachronous), and LMD location did not significantly influence OS or PFS. No statistically significant difference was found in OS or PFS between the chemotherapy and radiotherapy groups. Likewise, no difference was found in OS or PFS according to the use of craniospinal irradiation vs. less extensive RT fields.
  
  
  CONCLUSIONS
  Approximately one-half of PA patients were alive 5 years after the diagnosis of LMD. Both chemotherapy and radiotherapy have efficacy against LMD. Although the use of craniospinal irradiation did not have an effect on PFS, the patient numbers were small and a larger number treated with craniospinal irradiation is needed to determine its efficacy.
authors.affiliation: Department of Radiation Oncology, Methodist Hospital, Houston, TX 77030, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mazloom
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Hodges
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.forename: Murali
authors.initials: M
authors.lastname: Chintagumpala
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
mesh_terms: D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D016019:Survival Analysis; D055815:Young Adult