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Spina A, Garbin E, Albano L, Bisoglio A, Boari N, Mortini P. Gamma Knife radiosurgery for central neurocytoma: a quantitative systematic review and metanalysis. Neurosurg Rev 2024; 47:64. [PMID: 38265530 DOI: 10.1007/s10143-024-02301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
Central neurocytomas (CN) are rare tumors within the central nervous system. Originating from the septum pellucidum and subependymal cells, they are typically found in the third and lateral ventricles. For this reason, they may lead to hydrocephalus and increased intracranial pressure. CNs are generally benign lesions that exhibit locally aggressive behavior and a high recurrence rate. Complete surgical resection is the preferred treatment; however, due to their anatomical location, this is often not feasible. Based on these findings, Gamma Knife radiosurgery (GKRS) has been introduced for managing both residual and recurrent tumors and as an initial therapy in selected cases. This study aimed to systematically review the available knowledge regarding GKRS for CN. A systematic investigation of the scientific literature was undertaken through an exhaustive search across prominent databases, including PubMed, Web of Science, and Google Scholar, by employing precise MeSH terms such as "Central neurocytoma," "Radiosurgery," "Gamma Knife," and "Stereotactic Radiosurgery." A comprehensive quantitative systematic review and meta-analysis were meticulously conducted, focusing on cases of CN treated with GKRS for a thorough evaluation of outcomes and efficacy. Seventeen articles, including 289 patients, met the inclusion criteria. Random effects meta-analysis estimates for disease control and local tumor control were 90% (95% CI 87-93%; I2 = 0%, p < 0.74) and 94% (95% CI 92-97%; I2 = 0%, p < 0.98), respectively. When considering only studies with at least 5 years of follow-up, progression-free survival was 89% (95% CI 85-94%; I2 = 0.03%, p < 0.74). The mean clinical control rate was 96%. This systematic review and meta-analysis confirmed the safety and efficacy of GKRS in managing CN.
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Affiliation(s)
- Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Enrico Garbin
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Bisoglio
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Nicola Boari
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Xie Q, Xie B, Ou L, Wang M, Tang Z, He Y, Yang X, Hong J, Lyu Z, Wei R. Clinical Outcomes and Prognostic Analysis of 101 Patients of Central Neurocytoma: A 10-Year Treatment Experience at a Single Institution. Front Oncol 2022; 12:881460. [PMID: 35692765 PMCID: PMC9185842 DOI: 10.3389/fonc.2022.881460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/20/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Central neurocytoma (CN) is a rare type of tumor that currently lacks an optimal treatment protocol. This study aimed to explore the clinical outcomes of CN in a cohort of 101 patients and identify prognostic factors associated with multiple treatment modalities. Methods This monocentric study retrospectively analyzed the clinical data of 101 CN patients who underwent surgical resection. The patients were followed up, and their overall survival (OS) and progression-free survival (PFS) were calculated. Results For the entire cohort, the 5- and 10-year OS rates were 88.7% and 82.8%, respectively, and the 5- and 10-year PFS rates were 86.5% and 64.9%, respectively. Of the 82 (81.19%) patients with CN who underwent gross total resection (GTR), 28 (28/82, 34.1%) also received radiotherapy (RT). Of the 19 (18.81%) patients with CN who underwent subtotal resection (STR), 11 (11/19, 57.9%) also received RT or stereotactic radiosurgery (SRS). Compared to STR, GTR significantly improved the 5-year OS (92.4% vs. 72.4%, P=0.011) and PFS (92.4% vs. 60.4%, P=0.009) rates. Radiotherapy did not affect OS in the GTR group (p=0.602), but it had a statistically significant effect on OS in the STR group (P<0.001). However, the OS (P=0.842) and PFS (P=0.915) in the STR plus radiotherapy group were comparable to those in the GTR alone group. Compared to STR alone, STR plus radiotherapy improved the 5-year PFS rate from 25% to 75% in patients with atypical CN (P=0.004). Cox regression models and a competing risk model showed that the removal degree and radiotherapy were independent prognostic factors for survival. With improvements in modern radiotherapy techniques, severe radiotherapy toxicity was not observed. Conclusion Our findings support the use of GTR whenever possible. Radiotherapy can improve the prognosis of patients who undergo STR, especially in atypical CNs having a higher tendency to relapse. Close imaging follow-up is necessary. Our findings will help clinicians to select optimal, individualized treatment strategies to improve OS and PFS for patients with CN.
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Affiliation(s)
- Qiongxuan Xie
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Xie
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Ludi Ou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Min Wang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqing Tang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuxiang He
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyu Yang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jidong Hong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiping Lyu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Abstract
OBJECTIVE
This study was performed to evaluate the role of Gamma Knife radiosurgery (GKRS) as a primary treatment for central neurocytomas (CNs).
METHODS
The authors retrospectively assessed the treatment outcomes of patients who had undergone primary treatment with GKRS for CNs in the period between December 2001 and December 2018. The diagnosis of CN was based on findings on neuroimaging studies. The electronic medical records were retrospectively reviewed for additional relevant preoperative data, and clinical follow-up data had been obtained during office evaluations of the treated patients. All radiographic data were reviewed by a dedicated neuroradiologist.
RESULTS
Fourteen patients were treated with GKRS as a primary treatment for CNs in the study period. Seven patients (50.0%) were asymptomatic at initial presentation, and 7 (50.0%) presented with headache. Ten patients (71.4%) were treated with GKRS after the diagnosis of CN based on characteristic MRI findings. Four patients (28.6%) initially underwent either stereotactic or endoscopic biopsy before GKRS. The median tumor volume was 3.9 cm3 (range 0.46–18.1 cm3). The median prescription dose delivered to the tumor margin was 15 Gy (range 5.5–18 Gy). The median maximum dose was 30 Gy (range 11–36 Gy). Two patients were treated with fractionated GKRS, one with a prescription dose of 21 Gy in 3 fractions and another with a dose of 22 Gy in 4 fractions. Control of tumor growth was achieved in all 14 patients. The median volume reduction was 26.4% (range 0%–78.3%). Transient adverse radiation effects were observed in 2 patients but resolved with improvement in symptoms. No recurrences were revealed during the follow-up period, which was a median of 25 months (range 12–89 months).
CONCLUSIONS
Primary GKRS for CNs resulted in excellent tumor control rates without recurrences. These results suggest that GKRS may be a viable treatment option for patients with small- to medium-sized or incidental CNs.
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Hung YC, Lee CC, Yang HC, Mohammed N, Kearns KN, Sun SB, Mathieu D, Touchette CJ, Atik AF, Grills IS, Squires B, Ding D, Williams BJ, Yusuf MB, Woo SY, Liscak R, Hanuska J, Shiao JC, Kondziolka D, Lunsford LD, Xu Z, Sheehan JP. Stereotactic radiosurgery for central neurocytomas: an international multicenter retrospective cohort study. J Neurosurg 2020; 134:1122-1131. [PMID: 32244212 DOI: 10.3171/2020.1.jns191515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Central neurocytomas (CNs) are uncommon intraventricular tumors, and their rarity renders the risk-to-benefit profile of stereotactic radiosurgery (SRS) unknown. The aim of this multicenter, retrospective cohort study was to evaluate the outcomes of SRS for CNs and identify predictive factors. METHODS The authors retrospectively analyzed a cohort of patients with CNs treated with SRS at 10 centers between 1994 and 2018. Tumor recurrences were classified as local or distant. Adverse radiation effects (AREs) and the need for a CSF shunt were also evaluated. RESULTS The study cohort comprised 60 patients (median age 30 years), 92% of whom had undergone prior resection or biopsy and 8% received their diagnosis based on imaging alone. The median tumor volume and margin dose were 5.9 cm3 and 13 Gy, respectively. After a median clinical follow-up of 61 months, post-SRS tumor recurrence occurred in 8 patients (13%). The 5- and 10-year local tumor control rates were 93% and 87%, respectively. The 5- and 10-year progression-free survival rates were 89% and 80%, respectively. AREs were observed in 4 patients (7%), but only 1 was symptomatic (2%). Two patients underwent post-SRS tumor resection (3%). Prior radiotherapy was a predictor of distant tumor recurrence (p = 0.044). Larger tumor volume was associated with pre-SRS shunt surgery (p = 0.022). CONCLUSIONS Treatment of appropriately selected CNs with SRS achieves good tumor control rates with a reasonable complication profile. Distant tumor recurrence and dissemination were observed in a small proportion of patients, which underscores the importance of close post-SRS surveillance of CN patients. Patients with larger CNs are more likely to require shunt surgery before SRS.
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Affiliation(s)
- Yi-Chieh Hung
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,2Department of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.,3Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,5School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nasser Mohammed
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kathryn N Kearns
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Shi-Bin Sun
- 6Gamma Knife Center, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, China
| | - David Mathieu
- 7Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Charles J Touchette
- 7Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Ahmet F Atik
- 8Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Inga S Grills
- 9Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Bryan Squires
- 9Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | | | | | - Mehran B Yusuf
- 11Radiation Oncology, University of Louisville, Kentucky
| | - Shiao Y Woo
- 11Radiation Oncology, University of Louisville, Kentucky
| | - Roman Liscak
- 12Departments of Stereotactic and Radiation Neurosurgery and
| | | | - Jay C Shiao
- 14Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Douglas Kondziolka
- 15Department of Neurosurgery, NYU Langone Health System, New York, New York; and
| | - L Dade Lunsford
- 16Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Zhiyuan Xu
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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Park SJ, Jung TY, Kim SK, Lee KH. Tumor control of third ventricular central neurocytoma after gamma knife radiosurgery in an elderly patient: A case report and literature review. Medicine (Baltimore) 2018; 97:e13657. [PMID: 30558064 PMCID: PMC6320117 DOI: 10.1097/md.0000000000013657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Central neurocytoma is rare benign tumor that occurs in high probability in young adults in the lateral ventricle. Herein, we report an unusual case of an elderly woman who was diagnosed with central neurocytoma isolated to the third ventricle. This deeply located tumor was effectively treated using gamma knife radiosurgery (GKR). PATIENT CONCERNS A 79-year-old woman was admitted to hospital with gait disturbance and cognitive dysfunction. DIAGNOSIS Brain magnetic resonance imaging (MRI) revealed a homogenously enhancing multilobulated mass in the posterior third ventricle measuring 1.8 cm in size. The tumor was diagnosed as a central neurocytoma isolated to the third ventricle. INTERVENTIONS Neuronavigation-guided endoscopic third ventriculostomy and biopsy were performed. One week following surgery, GKR was performed using a prescribed dose of 14 Gy with 50% isodose lines, and a target volume of 1.62 cc. OUTCOMES Three months after GKR, brain MRI revealed a decrease in the size (to 1.4 cm) of the multilobulated strong enhancing mass in the posterior third ventricle, and the patient's symptom of confusion was improved. LESSONS Previous studies have reported that tumors in unusual locations, such as those isolated to the third ventricle, are different according to age, either in young children or elderly individuals. Although complete surgical resection is an effective treatment for central neurocytoma, it is often difficult to approach these tumors through surgery. GKR could, therefore, be an alternative primary treatment option for deeply located central neurocytomas in elderly patients.
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Affiliation(s)
| | | | | | - Kyung-Hwa Lee
- Pathology, Chonnam National University Medical School, Chonnam National University Hospital and Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
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Wang Y, Gao X, Ge Y. Letter to the Editor Regarding “Clinical Features, Treatment, and Long-Term Outcomes of Central Neurocytoma: 20-Year Experience at a Single Center”. World Neurosurg 2018; 111:433. [DOI: 10.1016/j.wneu.2017.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022]
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Wang M, Zhou P, Zhang S, Liu X, Lv L, Wang Z, Ye F, Wang X, Jiang S. Clinical Features, Treatment, and Long-term Outcomes of Central Neurocytoma: A 20-Year Experience at a Single Center. World Neurosurg 2017; 109:e59-e66. [PMID: 28958923 DOI: 10.1016/j.wneu.2017.09.103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Central neurocytoma (CN) is a rare central nervous system tumor the optimal management strategy of which remains controversial because of their rarity. Detailed information on CN is necessary to establish optimal management strategies. The purpose of this study was to show the clinical features, treatments, and long-term clinical outcomes of CN. METHODS A total of 63 patients with CN were surgically treated between 1995 and 2016 at West China Hospital. All pathologically proven CN cases were identified. Epidemiologic characteristics, clinical features, imaging features, functional outcomes, overall survival, and progression-free survival according to multimodal treatments were reviewed retrospectively. RESULTS There were 29 males and 34 females, with a median age of 29 years (range, 15-58 years). Thirty-four patients underwent gross total resection (GTR) and 29 patients underwent subtotal resection (STR). The surgical approaches to CNs in this study included a transcortical approach (39 cases) and an interhemispheric transcallosal approach (24 cases). There were no differences in functional outcomes or initial extent of resection according to the surgical approach used. The extent of resection was GTR in 34 patients (54.0%), and STR in 29 patients (46.0%). At the median follow-up of 74 months (range, 6-205 months), the actuarial 5-year and 10-year overall survival were 93.3% and 85.4%. At the last follow-up, 8 patients had experienced tumor progression. The 5-year and 10-year progression-free rate was 73.4% and 57.5%. The initial extent of resection and multimodal treatment was not related to overall survival; however, the actuarial local control rate differed significantly according to the initial extent of resection and multimodal treatment. CONCLUSIONS CN is a rare type of World Health Organization grade II primary brain tumor with a tendency to recur. Complete resection of CNs with maximal safety remains the primary treatment to minimize local progression. Adjuvant radiotherapy should be considered in patients receiving incomplete resection. The long-term clinical outcomes of CN after multimodal treatment seem to be satisfactory.
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Affiliation(s)
- Mengmeng Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shizhen Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xueyou Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Liang Lv
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Zeming Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Feng Ye
- Department of Neurosurgery, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Xiang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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