Long-term radiosurgical control of subtotally resected adult pineocytomas.
OBJECTIVE
The optimal management of pineocytomas remains controversial. Although the value of complete microsurgical removal is well accepted, gross-total resection is not always feasible. Data regarding the role of postoperative adjuvant stereotactic radiosurgery (SRS) for residual disease is limited and conflicting. Here, the authors review the largest single-institution experience with multimodal pineocytoma management in an effort to quantify the utility of adjuvant radiosurgical treatment of residual disease.


METHODS
The medical records and radiographic studies for all patients with histologically confirmed pineocytoma at the Barrow Neurological Institute between 1999 and 2011 were retrospectively reviewed. Clinical and radiographic data, including the volumetric extent of resection, were collected retrospectively, and Kaplan-Meier analysis was used to identify progression-free survival.


RESULTS
Fourteen adults with newly diagnosed pineocytomas were surgically treated in the period from 1999 to 2011. The median clinical and radiographic follow-ups were 44 and 53 months, respectively. Twelve patients (86%) underwent microsurgical removal and 2 (14%) underwent endoscopic biopsy. Five patients (36%) had complete resections and 9 (64%) demonstrated residual disease. Three patients (21%) presented with radiographic recurrence at a median interval of 43 months after initial treatment (range 13-83 months). At the time of recurrence, the median preoperative tumor volume was 2.6 cm(3). Adjuvant SRS was used to treat 3 subtotally resected tumors (33%) following initial presentation and 2 (66%) at the time of recurrence. Among patients with subtotally resected tumors, progression-free survival was significantly longer (p < 0.05) for those who did as compared with those who did not undergo adjuvant radiosurgery. To date, no patient who underwent adjuvant radiosurgery has demonstrated radiographic or clinical evidence of disease progression.


CONCLUSIONS
Microsurgical removal remains the definitive treatment for pineocytomas, yet residual disease can be effectively controlled using adjuvant SRS.
Division of Neurological Surgery, Barrow Neurological Institute, 310 North Third Avenue, Phoenix, Arizona 85013, USA.
David A
DA
Wilson
Al-Wala
AW
Awad
David
D
Brachman
Stephen W
SW
Coons
Heyoung
H
McBride
Emad
E
Youssef
Peter
P
Nakaji
Andrew G
AG
Shetter
Kris A
KA
Smith
Robert F
RF
Spetzler
Nader
N
Sanai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010870:Pineal Gland / Q000473:pathology / Q000601:surgery*; D010871:Pinealoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult