DDEL-02INTRA-ARTERIAL CHEMOTHERAPY FOR RECURRENT PILOCYTIC ASTROCYTOMA

BACKGROUND: Pilocytic astrocytoma (PA) in general is a well differentiated low grade glioma. However, some are more aggressive and progress after initial resection and require repeat resection, radiation and/or chemotherapy. At recurrence overall survival in those who received prior radiation for a pilocytic astrocytoma precursor is shorter. In addition there is the concern for long term neuro-cognitive impairment as a result of brain radiation. We report the responses to carboplatin based intra-arterial (IA) chemotherapy for recurrent or progressive PA. METHODS: This retrospective review was IRB approved. 150 patients with histology confirmed pilocytic astrocytoma were diagnosed between 1997 and 2014. Twenty two had recurrences. Patient characteristics, treatment at progression, best responses, time to progression and duration of response overall survival differences between patients that received carboplatin based IA chemotherapy vs those that received alternate therapies were analyzed. Images were reviewed and response assessment was confirmed by a neuro-radiologist. RESULTS: Eleven patients received intra-arterial chemotherapy [6 were 18 years]. The remaining 11 received alternate therapies for recurrent PA. All had radiographically confirmed evidence of recurrent or progressive disease at the time of start of therapy IA therapy (8 supra-tentorial and 3 Infra-tentorial recurrences).6/11 patients that received IA therapy had failed prior therapies prior to starting IA chemotherapy, including one patient who progressed after intravenous carboplatin based therapy. Five patients were treated at first progression. One had radiation prior to IA therapy. 1 complete response, 3 partial responses and 7 stable diseases were noted in the IA group. 7/11(64%) had durable responses for over 2 years. CONCLUSION: Durable responses are possible with Carboplatin based IA chemotherapy in patients with recurrent PA even when they have failed IV therapy with similar regimens. IA chemotherapy may help delay radiation.