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Malignant Pineal Parenchymal Tumors in Adults: A National Cancer Database Analysis
Eric J Chalif1,2, Richard D Murray1,3,4, Khashayar Mozaffari1
1Department of Neurosurgery, The George Washington University, Washington, District of Columbia, USA.
Background:
Limited retrospective data exist on malignant pineal parenchymal tumors (PPTs) in adults, and there are no large previous studies that review clinical outcomes across the 3 treatment arms of surgery, radiotherapy, and chemotherapy. As a result, optimal disease management has yet to be defined.
Objective:
To evaluate treatment trends and perform survival analysis in adult PPT.
Methods:
The National Cancer Database was queried for histologically confirmed PPT diagnosed from 2007 to 2016. Univariate and multivariate Cox regressions were used to evaluate the prognostic impact of covariates. Kaplan-Meier survival curves were generated for comparative subanalyses.
Results:
Of the 251 patients who met inclusion criteria, 172 had PPTs of intermediate differentiation (PPTID) and 79 had pineoblastoma. A plurality of patients with pineoblastoma were treated with trimodal therapy (39.1%), whereas patients with PPTID were commonly treated with either surgery alone or surgery and radiation (33.7% each). Factors independently associated with improved overall survival include younger patient age, female sex, lower comorbidity score, lower tumor grade, and treatment with surgery or radiation (each P < .05). Subanalyses confirm the effect of radiation on survival in patients with grade III PPTID with subtotal resection; however, no survival benefit of adjuvant radiation is demonstrated in patients with grade II PPTID with subtotal resection.
Conclusion:
Although radiotherapy and surgery were found to increase survival in all patients with PPT, there was no demonstrable survival benefit of adjuvant radiation in surgically treated patients with grade II PPTID. This suggests that adjuvant radiotherapy may not add significant survival benefit in many adult patients with grade II PPTID.
Insights
Surgery and radiotherapy improve survival for adult malignant pineal parenchymal tumors (PPTs). However, adjuvant radiation offers no survival benefit for grade II PPTs after subtotal resection, suggesting personalized treatment approaches.
Area of Science:
- Neuro-oncology
- Surgical oncology
- Radiation oncology
Background:
- Malignant pineal parenchymal tumors (PPTs) in adults are rare, with limited data on optimal management.
- Previous studies lack comprehensive analysis of clinical outcomes across surgery, radiotherapy, and chemotherapy for adult PPTs.
Purpose of the Study:
- To analyze treatment trends and survival outcomes in adult patients with PPTs.
- To identify prognostic factors influencing overall survival in adult PPT patients.
Main Methods:
- Retrospective analysis of the National Cancer Database (2007-2016) for histologically confirmed PPTs.
- Utilized univariate and multivariate Cox regression for prognostic impact assessment.
- Generated Kaplan-Meier survival curves for comparative subanalyses.
Main Results:
- 251 adult patients with PPTs (172 PPTs of intermediate differentiation, 79 pineoblastoma) were analyzed.
- Pineoblastoma patients predominantly received trimodal therapy; PPTID patients received surgery alone or surgery plus radiation.
- Younger age, female sex, lower comorbidity, lower tumor grade, and treatment with surgery or radiation were associated with improved survival.
Conclusions:
- Both radiotherapy and surgery enhance survival in adult PPT patients.
- Adjuvant radiotherapy did not demonstrate a survival benefit in surgically treated patients with grade II PPTID and subtotal resection.
- Personalized treatment strategies may be warranted, as adjuvant radiotherapy may not significantly benefit all adult patients with grade II PPTID.
