title: Prognostic factors and therapeutic outcomes in 22 patients with pleomorphic xanthoastrocytoma.
abstract: OBJECTIVE
  Pleomorphic xanthoastrocytoma (PXA) is a rare primary low-grade astrocytic tumor classified as WHO II. It is generally benign, but disease progression and malignant transformation have been reported. Prognostic factors for PXA and optimal therapies are not well known.
  
  
  METHODS
  The study period was January 2000 to March 2012. Data on MR findings, histology, surgical extents and adjuvant therapies were reviewed in twenty-two patients diagnosed with PXA.
  
  
  RESULTS
  The frequent symptoms of PXA included seizures, headaches and neurologic deficits. Tumors were most common in the temporal lobe followed by frontal, parietal and occipital lobes. One patient who died from immediate post-operative complications was excluded from the statistical analysis. Of the remaining 21 patients, 3 (14%) died and 7 (33%) showed disease progression. Atypical tumor location (p<0.001), peritumoral edema (p=0.022) and large tumor size (p=0.048) were correlated with disease progression, however, Ki-67 index and necrosis were not statistically significant. Disease progression occurred in three (21%) of 14 patients who underwent GTR, compared with 4 (57%) of 7 patients who did not undergo GTR, however, it was not statistically significant. Ten patients received adjuvant radiotherapy and the tumors were controlled in 5 of these patients.
  
  
  CONCLUSIONS
  The prognosis for PXA is good; in our patients overall survival was 84%, and event-free survival was 59% at 3 years. Atypical tumor location, peritumoral edema and large tumor size are significantly correlated with disease progression. GTR may provide prolonged disease control, and adjuvant radiotherapy may be beneficial, but further study is needed.
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sungryong
authors.initials: S
authors.lastname: Lim
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Sun A
authors.initials: SA
authors.lastname: Kim
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Park
authors.forename: Young Shin
authors.initials: YS
authors.lastname: Ra
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Kim
keywords: Pleomorphic xanthoastrocytoma; Prognosis; Radiotherapy; outcome
references.citation: Cancer. 1999 May 1;85(9):2033-45
references.pmid: 10223246
references.citation: AJNR Am J Neuroradiol. 2005 Nov-Dec;26(10):2466-74
references.pmid: 16286386
references.citation: J Neurooncol. 2012 Oct;110(1):99-104
references.pmid: 22843450
references.citation: Am J Surg Pathol. 1986 May;10(5):336-41
references.pmid: 3010749
references.citation: Cancer. 1979 Nov;44(5):1839-52
references.pmid: 498051
references.citation: Histopathology. 2008 Jan;52(2):183-93
references.pmid: 18184267
references.citation: AJNR Am J Neuroradiol. 1993 Nov-Dec;14(6):1397-404
references.pmid: 8279337
references.citation: Acta Neurochir (Wien). 2006 Jan;148(1):67-71; discussion 71
references.pmid: 15912255
references.citation: J Neurol Sci. 2007 Jan 31;252(2):144-53
references.pmid: 17189643
references.citation: Cancer. 1983 Dec 1;52(11):2055-63
references.pmid: 6194876
references.citation: Cancer. 1996 Dec 15;78(12):2551-63
references.pmid: 8952564
references.citation: Neuro Oncol. 2009 Aug;11(4):446-51
references.pmid: 19164434
references.citation: J Clin Oncol. 2002 Apr 15;20(8):2076-84
references.pmid: 11956268
references.citation: J Neurooncol. 1996 Jan;27(1):65-73
references.pmid: 8699228
references.citation: Acta Neuropathol. 1987;74(2):142-50
references.pmid: 3673505
references.citation: Eur J Neurol. 2009 Jul;16(7):874-8
references.pmid: 19473360
references.citation: Hum Pathol. 1991 Nov;22(11):1128-35
references.pmid: 1743696
references.citation: Neuropathology. 2010 Aug;30(4):443-8
references.pmid: 20051018
references.citation: Cancer. 1997 Dec 1;80(11):2141-50
references.pmid: 9392337
references.citation: Chin Med J (Engl). 2012 Jan;125(2):396-9
references.pmid: 22340580
references.citation: Neuro Oncol. 2001 Jul;3(3):184-92
references.pmid: 11465399
references.citation: Neuroradiology. 2007 Apr;49(4):307-15
references.pmid: 17205313
references.citation: Neurosurg Focus. 2007 May 15;22(5):E8
references.pmid: 17613239
references.citation: J Clin Oncol. 2008 Mar 10;26(8):1338-45
references.pmid: 18323558
references.citation: AJR Am J Roentgenol. 1992 Dec;159(6):1287-90
references.pmid: 1442403
references.citation: J Neurosurg. 1993 Nov;79(5):761-8
references.pmid: 8410257
references.citation: Surg Neurol. 2007 Jul;68(1):89-94; discussion 94-5
references.pmid: 17537486
references.citation: J Neurooncol. 2001 Mar;52(1):63-72
references.pmid: 11451204
references.citation: Brain Pathol. 1993 Jul;3(3):269-74
references.pmid: 8293186
references.citation: Br J Neurosurg. 1994;8(6):681-9
references.pmid: 7718164
references.citation: Neurosurgery. 1996 Apr;38(4):822-8; discussion 828-9
references.pmid: 8692406
references.citation: Acta Radiol. 2011 Mar 1;52(2):223-8
references.pmid: 21498352
references.citation: Clin Neuropathol. 1993 Mar-Apr;12(2):97-101
references.pmid: 8477554
references.citation: Cancer. 1994 Sep 15;74(6):1784-91
references.pmid: 8082081