Clinical outcomes for pleomorphic xanthoastrocytoma patients
Jared J Sullivan1, James P Chandler2, Maciej S Lesniak2
1Department of Radiation Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA.
Background:
Report our institutional experience with pleomorphic xanthoastrocytoma (PXA) to contribute to limited data on optimal management.
Methods:
Patients with pathologically confirmed PXA treated at our institution between 1990 and 2019 were identified. Demographic information, tumor grade, treatment variables, and clinical outcomes were collected from patient charts. Kaplan-Meier estimates were used to summarize 2 primary outcome measurements: progression-free survival (PFS) and overall survival (OS). Outcomes were stratified by tumor grade and extent of resection. Cox regression and log-rank testing were performed.
Results:
We identified 17 patients with pathologically confirmed PXA. Two patients were excluded due to incomplete treatment information or <6 m of follow-up; 15 patients were analyzed (median follow-up 4.4 years). Six patients had grade 2 PXA and 9 had grade 3 anaplastic PXA. The 2- and 5-year PFS for the cohort was 57% and 33%, respectively; 2- and 5-year OS was 93% and 75%, respectively. Patients with grade 2 tumors exhibited superior PFS compared to those with grade 3 tumors (2-year PFS: 100% vs. 28%, 5-year PFS: 60% vs. 14%), hazard ratio, 5.09 (95% CI: 1.06-24.50), P = .02. Undergoing a gross total resection was associated with numerical longer survival but this was not of statistical significance (hazard ratio: 0.38, P = .15). All but one (89%) of the grade 3 patients underwent RT.
Conclusions:
The poor survival of the cohort, especially with grade 3 tumors, suggests the need for more aggressive treatment, including maximal resection followed by intensive adjuvant therapy. Better prognostics of tumor recurrence are needed to guide the use of adjuvant therapy.
