Clinical outcome and prognostic factors for central neurocytoma: twenty year institutional experience

Abstract

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.

Central Neurocytoma: A Review of Clinical Management and Histopathologic Features

“…A higher 5-year progression free survival has also been shown for patients who received adjuvant FRT after STR (67%) than patients without FRT (53%) [69]. …”

“…Imber et al [69] also found significantly improved survival rates when adjuvant radiotherapy is administered following STR. Patients with STR and FRT had a 67% 5-year survival rate, while patients with STR only had a 53% survival rate.…”

“…7). In 2015, Imber et al [69] measured progression-free survival (PFS) by Kaplan-Meier and Cox proportional hazards methods, and found that the two year PFS was 48% for MIB-1 LI >4%, and 90% for MIB-1 LI <4%. Similarly, CN with MIB-1 LI <2% had a 10-year survival rate of 90%, compared to MIB-1 LI >2%, which had a 10-year survival rate of 63%.…”

Intraventricular neuroepithelial tumors: Surgical outcome, technical considerations and review of literature

“…The tumor's rarity makes it challenging to de ne treatment standards. Most institutions, including our center, regrade surgical gross total resection as gold standard for treatment of central neurocytomas with complete removal rates of 30-50% (69)(70)(71)(72). In this cohort, we achieved gross total resection in 90.0% (9/10), table 6 summarize recent major case series reports and their ndings since 2000 (71,(73)(74)(75).…”

“…A systematic review by Garcia et al displayed that extent of resection was not predictive regarding improved local control (80), while a prospective multi-center study reported that in 71 patients, those with subtotal resection had a 3,8 times higher risk of recurrence (81). The role of gross total resection remains ambiguous, with several treatment pathways including external beam radiation therapy, stereotactic radiosurgery, re-operation and/or chemotherapy (71). Whether pathological subtypes or molecular patterns of central neurocytomas play a role in the course of disease and should guide therapy strategies remains unclear to date.…”