Pilocytic astrocytoma
ICD-10 C71.9 · ICD-11 2A00.0Y&XH29Q5

Pilocytic Astrocytoma in Adults: Management When Gross Total Resection Has Not Achieved Lasting Tumor Control

Clinical Scenario

This protocol applies to adult patients (age 18 years or older) with pilocytic astrocytoma in whom the initial surgical approach did not achieve durable local control — including those with inoperable, recurrent, progressive, or large residual tumors.

Prior Treatment & Its Unmet Goals

The first-line strategy — gross total resection — targets long-term local tumor control and cure, and seizure-freedom in patients presenting with seizures. When these goals are not met and disease progresses, recurs, or remains unresectable, a further management step is indicated.

Next-Line Approach (Partial Overview)

For eligible patients with recurrent, inoperable, or progressive disease, the next step may involve further surgical or radiation-based intervention — or a combination of both — tailored to individual tumor characteristics and patient status.

Patient selection criteria, the specific role of each modality, and the conditions under which each applies are detailed in the full structured protocol.

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Treatment goal: Improved local tumor control — no local tumor progression on imaging.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/neuonc/noac188

Repeated surgery in patients with local tumor progression or recurrence should be considered.

In case of local recurrence or progression, re-resection is to be considered in selected patients to achieve both tumor and symptom control (eg, hydrocephalus or refractory seizures).

Radiotherapy may have a role for inoperable tumors or following incomplete resection to improve local control depending on tumor grade, size, and location.

RT typically 50–54 Gy in 28–30 fractions, should be considered for grade 1 unresectable or large residual/progressive tumors.

Stereotactic radiosurgery, given at doses of 12–25 Gy in 1–5 fractions, may represent an option for small size recurrent tumors.

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