Clinical outcome and prognostic factors for central neurocytoma:  twenty year institutional experience.
Central neurocytomas are uncommon intraventricular neoplasms whose optimal management remains controversial due to their rarity. We assessed outcomes for a historical cohort of neurocytoma patients and evaluated effects of tumor atypia, size, resection extent, and adjuvant radiotherapy. Progression-free survival (PFS) was measured by Kaplan-Meier and Cox proportional hazards methods. A total of 28 patients (15 males, 13 females) were treated between 1995 and 2014, with a median age at diagnosis of 26 years (range 5-61). Median follow-up was 62.2 months and 3 patients were lost to follow-up postoperatively. Thirteen patients experienced recurrent/progressive disease and 2-year PFS was 75% (95% CI 53-88%). Two-year PFS was 48% for MIB-1 labeling >4% versus 90% for ≤4% (HR 5.4, CI 2.2-27.8, p = 0.0026). Nine patients (32%) had gross total resections (GTR) and 19 (68%) had subtotal resections (STR). PFS for >80% resection was 83 versus 67% for ≤80% resection (HR 0.67, CI 0.23-2.0, p = 0.47). Three STR patients (16%) received adjuvant radiation which significantly improved overall PFS (p = 0.049). Estimated 5-year PFS was 67% for STR with radiotherapy versus 53% for STR without radiotherapy. Salvage therapy regimens were diverse and resulted in stable disease for 54% of patients and additional progression for 38 %. Two patients with neuropathology-confirmed atypical neurocytomas died at 4.3 and 113.4 months after initial surgery. For central neurocytomas, MIB-1 labeling index >4% is predictive of poorer outcome and our data suggest that adjuvant radiotherapy after STR may improve PFS. Most patients requiring salvage therapy will be stabilized and multiple modalities can be effectively utilized.
Department of Radiation Oncology, University of California San Francisco (UCSF), San Francisco, CA, USA.
Brandon S
BS
Imber
Department of Radiation Oncology, University of California San Francisco (UCSF), San Francisco, CA, USA.
Steve E
SE
Braunstein
Department of Radiation Oncology, Indiana University School of Medicine, Bloomington, IN, USA.
Fred Y
FY
Wu
Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA.
Nima
N
Nabavizadeh
Department of Radiation Oncology, University of California San Francisco (UCSF), San Francisco, CA, USA.
Nicholas
N
Boehling
Department of Biostatistics, Helen Diller Family Comprehensive Cancer Center at University of California San Francisco (UCSF), San Francisco, CA, USA.
Vivian K
VK
Weinberg
Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.
Tarik
T
Tihan
Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.
Michael
M
Barnes
Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, USA.|Department of Pediatrics, University of California San Francisco (UCSF), San Francisco, CA, USA.|Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA.
Sabine
S
Mueller
Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, USA.
Nicholas A
NA
Butowski
Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, USA.
Jennifer L
JL
Clarke
Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, USA.
Susan M
SM
Chang
Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, USA.
Michael M
MM
McDermott
Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, USA.
Michael D
MD
Prados
Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, USA.
Mitchel S
MS
Berger
Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, 450 Brookline Ave, D1622, Boston, MA, 02215-5418, USA. dhaas-kogan@lroc.harvard.edu.
Daphne A
DA
Haas-Kogan
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018306:Neurocytoma / Q000175:diagnosis* / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult