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Abstract

Purpose

The benefit of external beam radiotherapy (EBRT) over Gamma Knife surgery (GKS) for central neurocytoma (CN) remains unclear. The aim of this retrospective, multicenter study was to investigate the role of adjuvant radiotherapy (ART) after surgical removal of CN and compare the outcomes of these modalities.

Methods

We included 128 patients with CN who underwent surgery during 2000–2020. Patients were categorized according to the extent of resection, Ki-67 labeling index, and ART modality. Progression-free survival (PFS) was assessed using Kaplan–Meier analysis and Cox proportional-hazards modeling.

Results

The median tumor size and follow-up duration were 5 cm and 66 months, respectively. ART was independently associated with an improved PFS (p = 0.005). Five-year PFS rates were higher among patients who received EBRT (n = 20, 95.0%), compared to GKS (n = 21, 78.3%, p = 0.061) and no radiotherapy (n = 87, 71.4%, p = 0.035). In the gross total resection and Ki-67 index > 2% subgroups, the PFS was higher in the EBRT group than that in the rest (p = 0.026). In patients with a Ki-67 index ≤ 2%, no PFS difference was observed between the ART and no-radiotherapy subgroups (p = 0.952). Among patients receiving ART, EBRT resulted in a longer PFS than GKS (p = 0.029 upon multivariable analysis).

Conclusions

ART may improve tumor control in patients with CN. Even in patients who undergo total resection, ART may be beneficial in the Ki-67 index > 2% subgroup. EBRT may result in superior PFS to GKS among patients with surgically resected CN.

Affiliations

Chan Woo Wee 1 2, Jong Won Park 1, Chang-Ok Suh 3, Do Hoon Lim 4, Nalee Kim 4, Doo-Sik Kong 5, Do-Hyun Nam 5, Joo Ho Lee 6 7, Chul-Kee Park 8, Seok-Gu Kang 2 9, Jong Hee Chang 2 9, Hong In Yoon 10 11
1Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
2Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
3Department of Radiation Oncology, Bundang CHA Medical Center, CHA University, Seongnam, Republic of Korea.
4Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
5Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
7Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
8Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
9Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
10Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. YHI0225@yuhs.ac.
11Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. YHI0225@yuhs.ac.