title: Choroid plexus tumors in adult and pediatric populations: the Cleveland Clinic and University Hospitals experience.
abstract: Choroid plexus tumors (CPT) are rare neoplasms accounting for 1-4% of all pediatric brain tumors. They are divided into choroid plexus papilloma (CPP), atypical choroid plexus papilloma (APP) and choroid plexus carcinoma (CPC). CPTs are known to primarily affect children less than 2 years of age. Gross total resection is the most important predictor of survival especially in CPC. Although small case series have been published, limited clinical data are available to describe treatment and outcome of CPTs. More clinical data would be necessary to complete the picture, particularly in populations that are not age limited. Here we share data from the two major hospitals in Cleveland to describe treatment and outcome of adult and pediatric patients. We performed a retrospective analysis of patients with CPT seen in Cleveland Clinic from 1990 to 2015 and at University Hospitals from 1994 to 2015. Results were compared to previously published historical controls. We identified 30 cases with CPT, including 22 pediatric and eight adult cases; 11 females and 19 males. The mean age at presentation was 12.4 years with a median age of 4.5 years (range 2 months-51 years). Gross total surgical resection was achieved in 22, subtotal resection in four, partial resection in two and unknown in two. The histology was CPP in 23 patients, two of whom developed recurrence requiring repeat resection and adjuvant therapy. Median event free survival (EFS) for CPP patients was 7.6 years. The histology was CPC in seven patients. All CPC patients were treated with adjuvant therapy. Median EFS of CPC patients was 4.4 years. Overall survival of all CPT patients was 100% with a median follow up of 7 years. A systematic literature review identified 1012 CPT patients treated from 1989 to 2013. The mean and median age of CPT patients was 13 and 3 years respectively. The median survival of 541 CPP patients was undefined vs. 2.7 years for the 452 CPC patients. The difference between the two populations was highly significant (p < 0.001). Kaplan-Meier survival curves comparing CPTs at Cleveland Clinic and University Hospitals versus a systematic literature review showed a statistically significant advancement in overall survival among the patients treated at Cleveland Clinic and University Hospitals. Our data are consistent with the literature review regarding epidemiology, clinical presentation, and treatment modalities but differed in regards to survival. Differences in survival may be related to different methods of data collection or details in patient care.
authors.affiliation: Department of Pediatric Hematology Oncology & Bone Marrow Transplantation, Cleveland Clinic Children's, S20 Cleveland Clinic Foundation 9500 Euclid Ave, Cleveland, OH, 44195, USA. michelle.bahar@gmail.com.
authors.forename: Michal
authors.identifier: 0000-0002-1088-7210
authors.initials: M
authors.lastname: Bahar
authors.affiliation: Department of Pediatric Hematology Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Hashem
authors.affiliation: Department of Pediatric Hematology Oncology & Bone Marrow Transplantation, Cleveland Clinic Children's, S20 Cleveland Clinic Foundation 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Tekautz
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Tang
authors.affiliation: Department of Pediatric Hematology Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: de Blank
authors.affiliation: Department of Pediatric Hematology Oncology & Bone Marrow Transplantation, Cleveland Clinic Children's, S20 Cleveland Clinic Foundation 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Johannes
authors.initials: J
authors.lastname: Wolff
mesh_terms: D000293:Adolescent; D000328:Adult; D002277:Carcinoma / Q000473:pathology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016545:Choroid Plexus Neoplasms / Q000473:pathology* / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020288:Papilloma, Choroid Plexus / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Choroid plexus carcinoma; Choroid plexus papilloma; Choroid plexus tumors; Pediatric and adult cases