Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Gumustepe E, Ozcan F, Colak O, Gursoy AT, Dursun CU, Tugcu AO, Dogru GD, Arslan R, Elcim Y, Gundem E, Dirican B, Beyzadeoglu M. Concise review of radiosurgery for contemporary management of pilocytic astrocytomas in children and adults. World J Exp Med 2022; 12(3): 36-43 [PMID: 35765513 DOI: 10.5493/wjem.v12.i3.36]
Corresponding Author of This Article
Omer Sager, MD, Associate Professor, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey. omersager@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Exp Med. May 20, 2022; 12(3): 36-43 Published online May 20, 2022. doi: 10.5493/wjem.v12.i3.36
Concise review of radiosurgery for contemporary management of pilocytic astrocytomas in children and adults
Omer Sager, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz, Esra Gumustepe, Fatih Ozcan, Onurhan Colak, Ahmet Tarik Gursoy, Cemal Ugur Dursun, Ahmet Oguz Tugcu, Galip Dogukan Dogru, Rukiyye Arslan, Yelda Elcim, Esin Gundem, Bahar Dirican, Murat Beyzadeoglu
Omer Sager, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz, Esra Gumustepe, Fatih Ozcan, Onurhan Colak, Ahmet Tarik Gursoy, Cemal Ugur Dursun, Ahmet Oguz Tugcu, Galip Dogukan Dogru, Rukiyye Arslan, Yelda Elcim, Esin Gundem, Bahar Dirican, Murat Beyzadeoglu, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey
Author contributions: Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Gumustepe E, Ozcan F, Colak O, Gursoy AT, Dursun CU, Tugcu AO, Dogru GD, and Arslan R played significant roles in data acquisition, interpretation of data, and reviewing and writing of the manuscript; Elcim Y, Gundem E, and Dirican B revised the manuscript for important intellectual content; Beyzadeoglu M took part in designing, reviewing, and writing the manuscript and revising the manuscript for important intellectual content; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Omer Sager, MD, Associate Professor, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 0090, Turkey. omersager@gmail.com
Received: September 30, 2021 Peer-review started: September 30, 2021 First decision: March 7, 2022 Revised: March 9, 2022 Accepted: April 21, 2022 Article in press: April 21, 2022 Published online: May 20, 2022
Abstract
Pilocytic astrocytoma (PA) may be seen in both adults and children as a distinct histologic and biologic subset of low-grade glioma. Surgery is the principal treatment for the management of PAs; however, selected patients may benefit from irradiation particularly in the setting of inoperability, incomplete resection, or recurrent disease. While conventionally fractionated radiation therapy has been traditionally utilized for radiotherapeutic management, stereotactic irradiation strategies have been introduced more recently to improve the toxicity profile of radiation delivery without compromising tumor control. PAs may be suitable for radiosurgical management due to their typical appearance as well circumscribed lesions. Focused and precise targeting of these well-defined lesions under stereotactic immobilization and image guidance may offer great potential for achieving an improved therapeutic ratio by virtue of radiosurgical techniques. Given the high conformality along with steep dose gradients around the target volume allowing for reduced normal tissue exposure, radiosurgery may be considered a viable modality of radiotherapeutic management. Another advantage of radiosurgery may be the completion of therapy in a usually shorter overall treatment time, which may be particularly well suited for children with requirement of anesthesia during irradiation. Several studies have addressed the utility of radiosurgery particularly as an adjuvant or salvage treatment modality for PA. Nevertheless, despite the growing body of evidence supporting the use of radiosurgery, there is need for a high level of evidence to dictate treatment decisions and establish its optimal role in the management of PA. Herein, we provide a concise review of radiosurgery for PA in light of the literature.
Core Tip: Radiosurgery for pilocytic astrocytomas may be utilized as part of initial management, as adjuvant therapy, or for the salvage of recurrences. Radiosurgery offers a convenient procedure by a condensed treatment schedule with rapid recovery. An improved toxicity profile may be achieved through optimal normal tissue sparing. Accurate setup verification under stereotactic immobilization and image guidance may be achieved, and the procedure is convenient with regards to staff and facility workload.
