Abstract

INTRODUCTION: Pilocytic astrocytomas (PAs) are WHO grade I neoplasms accounting for 5 to 6% of all gliomas, primarily affecting children and young adults with no gender predilection. Neoplasms such as pilocytic astrocytoma have excellent prognoses, even if resection has to be incomplete due to anatomic and other factors. Even though at least half of patients after subtotal (STR) or partial resection (PTR) will progress within 5 years, overall survival rates exceed 90%. PAs may remain quiescent after an incomplete resection suggests that tumors can exhibit decelerated growth kinetics over time and tumor cells may undergo senescence after an initial period of growth. Decisions regarding adjuvant radiation therapy are controversial after a STR or PTR. MATERIAL AND METHODS: A retrospective analysis of 10 consecutive surgical interventions on PAs that were treated at the Uzhhorod Regional Clinical Center of Neurosurgery and Neurology during the last 2.5 years (August 2014 to December 2016). The male-to-female ratio was 1:1. The mean age was 8 (from 3 to 17 years old). Localisation of tumors was as follows: brainstem - 3, optic pathways - 3, thalamus/hypothalamus - 2, cerebellum - 1, spinal cord - 1. In all patients the tumor cells show expression of GFAP and focal coexpression of Map2, all cases were without IDH1 mutation (variant R32H) and with preserved ATRX-expression.The mean Ki-67-labeling index for all the patients was 3 % RESULTS: According to the data, among the pilocytic astrocytoma prevail the tumors of the functionally eloquent areas (60%), with low mean proliferative index (3%). The degree of tumor removal: total/subtotal - 6 (60%), partial - 4 (40%) patients. There was no postoperative mortality. 3 (30%) received chemotherapy postoperatively and 7 had no adjuvant treatment. The results of treatment were assessed (median follow-up time - 10 month) according to Karnofsky scale: more than 60 points - 10 (100%) patients. CONCLUSIONS: In treating indolent tumors, the primary predictor of favourable oncological outcome is achieving maximum safe extent of the resection of the tumor. Significant long-term side effects make radiation difficult to justify as an adjuvant therapy in a patient population with excellent long-term survival. More prospective studies are needed to address the impact of modern radiation therapy technologies on patients outcome.

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