Frequent recurrence and progression in pilocytic astrocytoma in adults

Abstract

Objective: We compared use of intravenous (IV) normal saline (NS) to sodium bicarbonate (NaHCO3) with or without oral N‐acetylcysteine (NAC) for prevention of contrast‐induced acute kidney injury (CI‐AKI). Background: CI‐AKI is associated with significant adverse clinical events. Use of NAC has produced variable results. Recently, intravenous hydration with NaHCO3 for CI‐AKI prophylaxis has been adopted as standard treatment for patients with stable chronic renal disease undergoing catheterization procedures. Methods: We prospectively enrolled 320 patients with baseline renal insufficiency scheduled to undergo catheterization. Patients were randomly assigned to receive either IV NS ± NAC (n = 161) or IV dextrose 5% in water containing 154 mEq/l of NaHCO3 ± NAC (n = 159). IV NS was administered at 1 ml/kg body weight for 12 hr preprocedure and 12 more hr postprocedure. IV NaHCO3 was administered at 3 ml/kg body weight for 1 hr preprocedure followed by 1 ml/kg body weight postprocedure. A 1,200 mg oral dose of NAC was given 2–12 hr preprocedure and 6–12 hr postprocedure in 50% of patients in each study arm. CI‐AKI was defined as an increase of >0.5 mg/dl or >25% above baseline creatinine. Results: Overall incidence of CI‐AKI was 10.3%. There was no significant difference in incidence among the two groups (NS ± NAC 11.8% vs. NaHCO3 ± NAC 8.8%, p = ns). Incidence of CI‐AKI increased with increasing age (p = 0.001), contrast agent use >3 ml/kg body weight (p = 0.038) and diuretic use (p = 0.005). Conclusion: Incidence of CI‐AKI was no different in the NaHCO3 group compared to NS group, and NAC did not reduce CI‐AKI in the two study arms. © 2011 Wiley Periodicals, Inc.

Comparison of Perfusion, Diffusion, and MR Spectroscopy between Low-Grade Enhancing Pilocytic Astrocytomas and High-Grade Astrocytomas

“…This ambiguity can occur even in patients who are younger than 20 years of age, when age favors a diagnosis of PA, 1 as well as in adult patients, in whom PA is rare. 2 Advanced MR imaging techniques can help distinguish these entities much better than conventional imaging alone. 8,14,15 Enhanced accuracy helps in treatment planning and prognostication before surgery.…”

“…This tumor occurs most frequently in the first 2 decades of life, 1 composing up to 25% of brain tumors in pediatric neurosurgical practices, 2 and it only rarely occurs in adults. 2 The incidence is approximately 4.8 cases per million people per year, 3 with 2.3%-6% of all brain tumors classified as PAs. 3,4 PAs are usually clinically benign and are classified as grade I by the World Health Organization (WHO).…”

Primary Pilocytic Astrocytoma with Malign Transformation

“…RT plays a key role for malignant changes [6]. However, it is suggested that RT is not an effective factor by itself in malignant transformation [3,5]. In the present study, we present a PA case showing malignant transformation in a 3-year-old girl caused by 4 th ventricle with no previous RT history.…”

“…The treatment is surgical excision and chemotherapy (CT) and radiotherapy (RT) treatment can be applied in the presence of residual tumor or recurrence [2,3]. After total resection, the 10 year and 20 year surveys are 95.8% and 82%, respectively.…”

Pilocytic Astrocytoma With Histological Malignant Features Without Previous Radiation Therapy -Case Report-

“…8) Surgical resection should be considered as the initial treatment, and the administration of chemotherapy or radiation therapy remains controversial for residual or recurrent tumors. 3,11,14,15) The survival rate after macroscopic total resection is 95.8% at 10 years and 82% at 20 years, 2,5) indicating that this tumor generally has a benign clinical course. However, pilocytic astrocytoma has been known to transform to a malignant type.…”