title: Differences in the clinical courses of pediatric and adult pilocytic astrocytomas with progression: a single-institution study.
abstract: OBJECTIVE
  Pilocytic astrocytoma (PA) is a World Health Organization grade I neoplasm that generally follows a benign course. However, in some patients, PA exhibits an aggressive clinical course. Here, we examined the clinical course of pediatric and adult PAs with progression at a single institution.
  
  
  METHODS
  Between 1995 and 2013, 39 patients with PA were treated. Nineteen were pediatric patients (mean age, 12 years; range, 1-17 years) with a male-to-female patient ratio of 10:9, while 20 were adults (mean age, 36.4 years; range, 19-65 years) with a male-to-female ratio of 9:11. We analyzed and compared tumor location, extent of tumor resection, adjuvant treatment, and clinical course in all patients.
  
  
  RESULTS
  In the 19 pediatric patients, tumors were located in the cerebellar vermis, cerebellar hemisphere, optic pathways plus hypothalamus, hypothalamus, brainstem, and the temporal lobe in 6 (31.6%), 5 (26.3%), 3 (15.8%), 2 (10.5%), and 2 (10.5%) patients and 1 (5.3%) patient, respectively. The mass was totally, subtotally, or partially resected in 11 (57.9%), 2 (10.5%), and 4 (21.1%) patients, respectively; biopsies were performed in 2 (10.5%) patients. Immediate postoperative adjuvant treatment was carried out in 6 patients. Tumor progression was detected in 3 patients at 3.0, 4.6, and 5.2 years after treatment, respectively, without significant symptoms. In the 20 adult patients, tumors were located in the cerebellar hemisphere, cerebellar vermis, hypothalamus, brainstem, cerebral hemisphere, and lateral ventricle in 5 (25%), 4 (20%), 3 (15%), 3 (15%), 3 (15%), and 2 (10%) patients, respectively. The mass was totally, subtotally, or partially resected in 11 (55%) and 6 (30%) patients and 1 (5%) patient, respectively; biopsies were performed in 2 patients. Immediate adjuvant treatment was carried out in 2 patients. Progression was detected in 3 patients at 0.3, 0.9, and 2.5 years after treatment, respectively, with progressive neurologic symptoms. There was one case of disease-related mortality during follow-up among the adult patients.
  
  
  CONCLUSIONS
  Most of the PA cases evaluated in this study were benign. However, tumor progression in adult PAs followed a more aggressive clinical course than those in pediatric PAs.
authors: Brain Tumor Research Laboratory, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea.
authors: Hyang-Hwa
authors: HH
authors: Ryu
authors: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea. jung-ty@chonnam.ac.kr.
authors: Tae-Young
authors: TY
authors: Jung
authors: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea.
authors: Gwang-Jun
authors: GJ
authors: Lee
authors: Department of Pathology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors: Kyung-Hwa
authors: KH
authors: Lee
authors: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea.
authors: Seung-Hoon
authors: SH
authors: Jung
authors: Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea.
authors: Shin
authors: S
authors: Jung
authors: Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors: Hee-Jo
authors: HJ
authors: Baek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging; D001254:Astrocytoma / Q000175:diagnosis* / Q000628:therapy*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Adult; Clinical; Pediatric; Pilocytic astrocytoma; Progression; Radiology