• Kutluay Uluc, Dominic A Siler, Ricardo Lopez, Csanad Varallyay, Joao Prola Netto, Jenny Firkins, Cindy Lacy, Amy Huddleston, Prakash Ambady, and Edward A Neuwelt.
• Department of Neurology, Oregon Health & Science University, Portland, Oregon.
• Neurosurgery. 2021 Mar 15; 88 (4): E336E342E336-E342.

BackgroundProgressive and/or unresectable pilocytic astrocytomas (PAs) carry a poor prognosis compared to typical PA. Early radiotherapy (RT) may have severe long-term neurocognitive side effects in this patient population. Intra-arterial (IA) chemotherapy is a viable alternative or addition to intravenous (IV) chemotherapy, which may be beneficial in avoidance of early RT.ObjectiveTo evaluate the safety and efficacy of IA chemotherapy in this subset of patients.MethodsThis is a retrospective review of medical records of PA patients who are treated with IA chemotherapy at Oregon Health & Science University from 1997 until 2019. Response to treatment was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Progression free survival (PFS) and overall survival (OS) are also reported.ResultsTwelve patients were identified. All patients experienced progression prior to initiation of IA chemotherapy. The most common grade 3 or 4 toxicities related to chemotherapy were thrombocytopenia (66%), neutropenia (66%), leukopenia (50%), anemia (33%), and lymphopenia (16%). Responses achieved were CR in 1, PR in 3, SD in 7, and PD in 1. Median PFS and median OS were 16.5 and 83.5 mo, respectively. A total of 112 procedures (IA injections) were performed and 250 arteries were catheterized. There were 3 minor and no major complications attributable to procedures.ConclusionThis study demonstrates that IA chemotherapy can be safely used in patients with unresectable or progressive PA.© Congress of Neurological Surgeons 2021.

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