Introduction: A retrospective study evaluating demographics and outcomes in adult patients with intracranial pleomorphic xanthoastrocytoma (PXA).
Methods: We identified 30 adults with tissue-proven PXA operated between 1994 and 2011. Multiple demographic factors were recorded including Karnofsky Performance Status (KPS), complications, and mortality. These factors were statistically evaluated with univariate analysis.
Results: The mean age was 36.3 years at most recent surgery. Twenty-one (70%) patients had multiple surgeries with mean of 2 operations per patient. Nine (30%) PXAs were classified as grade III or IV (high-grade). Left-hemisphere, temporal lobe, and seizure-presentation were predominant. Pre-operative KPS>70 was found in 28 (93.3%) patients and long-term post-operative KPS>70 was identified in 27 (90%). Post-operative complications included neurological complications (36.7%), regional complications (13.3%), and medical complications (6.7%). While 11 patients (36.7%) experienced a neurological complication (6 with permanent deficit) at some point after any surgery, long-term functional outcome remained 90%. Mortality from tumor progression occurred in 6 (20%) patients and all had high-grade PXA. PXAs under 5 cm more often had regional complications (p=0.006) and high-grade PXAs were typically under 4 cm (p=0.005). Patients with high-grade PXAs more likely had prior surgeries (9/9; 100%; p=0.005), regional complications (3/9; 33%; p=0.04), adjuvant therapy administered (9/9; 100%; p<0.001), and mortality from tumor progression (6/9; 67%; p<0.001). Patients with pre-operative KPS>70 more often had post-operative short-term KPS>70 (27/28; 96%; p=0.015) and long-term KPS>70 (27/27; 100%; p=0.003).
Conclusions: PXA commonly occurs in children but also in adults. High-grade PXA was aggressively treated surgically and with adjuvant therapy. Those with neurological complications post-operatively were more likely to have worse short-term (<1 month) functional outcome but not worse long-term (>3 months) functional outcome. PXA may be aggressively treated with resection in adults as functional outcomes are good and many neurologic complications are not associated with decreased long-term functional outcome.
Patient Care: Increased knowledge of outcomes regarding surgical treatment of pleomorphic xanthroastrocytoma in adults.
Learning Objectives: -Long term functional outcomes after PXA surgery are good, even in the setting of a high rate of perioperative neurological complications
-High grade PXAs were typically under 4cm and tumors under 5cm more often had regional complications
-Patients with a preoperative KPS score of greater than 70 more often had a post-operative KPS score of greater than 70 both short and long term post-operatively