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Retrospective Clinical Studies |
Departments of Radiation Oncology (D.R., F.F., W.A.), Neurosurgery (K.L., M.W.), and Neuropathology (C.H.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ 85259 (S.E.S.), USA
1 Address correspondence to Dirk Rades, Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany (Rades.Dirk{at}gmx.net).
Abstract
Most neurocytomas are well differentiated, being associated with better
long-term survival than the more aggressive atypical lesions. Atypical
neurocytomas are characterized by an MIB-1 labeling index >3% or atyp-ical
histologic features. This analysis focuses on well-differentiated neurocytomas
in order to define the optimal treatment. A case with a follow-up of 132
months is presented. The patient developed two recurrences two and four years
after first surgery, each showing an increasing proliferation activity.
Furthermore, all published well-differentiated neurocytoma cases were reviewed
for surgery, radiotherapy, and prognosis. Additional rel-evant data were
obtained from the authors. Complete resection (CTR), complete resection plus
radiotherapy (CTR + RT), incomplete resection (ITR), and incomplete resection
plus radiotherapy (ITR + RT) were compared for outcome by using the
Kaplan-Meier method and the log-rank test. Data were complete in 301 patients
(CTR, 108; CTR + RT, 27; ITR, 81; ITR + RT, 85). Local control and survival
were better after CTR than after ITR (P < 0.0001 and P =
0.0085, respectively). Radiotherapy improved local control after ITR
(P < 0.0001) and after CTR (P = 0.0474), but not survival
(P = 0.17 and P = 1.0, respectively). In the ITR + RT group,
doses 
54 Gy (n = 33) and >54 Gy (n = 32) were not significantly
different for local control (P = 0.88) and survival (P =
0.95). The data demonstrated CTR to be superior to ITR for local control and
survival. After CTR and ITR, radiotherapy improved local control, but not
survival. A radiation dose of 54 Gy appeared sufficient. Application of
postoperative radiotherapy should be decided individually, taking into account
the risk of local failure, the need for another craniotomy, and potential
radiation toxicity.
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