Efficacy and safety of proton radiotherapy for progressive or surgically unfavorable adult pilocytic astrocytoma: a single-center experience.

Authors

Fabian J K Allmendinger, Yuliia Cherniienko, Jonathan Lischalk, Jannik Walter, Lucas Mose, Ricarda Wickert, Maximilian Deng, Sebastian Regnery, Lars Wessel, Katharina Kozyra, Thomas Tessonnier, Sandro Krieg, Jürgen Debus, Laila König, Tanja Adena-Eichkorn

Published in

Journal of neuro-oncology. Volume 179. Issue 3. Sep 18, 2026. Epub Sep 18, 2026.

Abstract

Progressive adult pilocytic astrocytoma is rare, and management of surgically unfavorable disease remains insufficiently defined. Given the favorable long-term prognosis of WHO grade 1 glioma, local tumor control must be balanced against late toxicity. This study evaluated the efficacy and safety of PRT in adults with pilocytic astrocytoma.
Fourteen adult patients with progressive or surgically unfavorable pilocytic astrocytoma treated with PRT at a single institution were retrospectively analyzed. Patient, tumor, treatment, radiographic, survival, and toxicity data were assessed. Radiographic response was evaluated using bidirectional T2-weighted measurements. Overall survival (OS), progression-free survival (PFS), and radiation-induced contrast enhancement (RICE)-free probability were estimated using Kaplan-Meier analysis. Toxicity was graded according to CTCAE.
Median prescribed dose was 54.0 Gy(RBE). PRT was delivered as salvage treatment in 10 patients (71%) or primary therapy in 4 patients (29%). Tumors frequently involved anatomically complex regions, including the posterior fossa, ventricular and midline structures, the optic pathway, and the suprasellar compartment. At last follow-up, radiographic regression included complete response in 3, partial response in 7, and minor response in 2 of 14 patients. Estimated OS at 3 and 5 years was 100%, whereas estimated PFS was 83.3% at both time points. RICE occurred in 3 patients, with 3- and 5-year RICE-free probabilities of 76.2%. Toxicity was predominantly low grade, with no grade 4 or 5 events.
PRT was associated with durable tumor control, marked radiographic regression, favorable survival, and acceptable toxicity in selected adults with progressive or surgically unfavorable pilocytic astrocytoma.

PMID:
42758412
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.

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