{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:15:27Z","timestamp":1789773327294,"version":"4.0.1"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Pilocytic astrocytomas are circumscribed WHO grade I gliomas that predominantly affect children, although they also occur in adults. While maximal safe resection is standard treatment, until recently chemotherapy was often used in pediatrics with irresectable symptomatic tumors to delay radiotherapy. As evidence for this approach in adults is limited, we performed a multicenter retrospective cohort study on this subject.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients (\u2265\u200916 years) treated with chemotherapy between 2006 and 2020 across eight Dutch medical centers were included. Treatment response was centrally assessed using RAPNO criteria and survival outcomes were analyzed using the Kaplan\u2013Meier method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty-one patients with pilocytic astrocytoma were included (median age 27 years). Most patients had received prior treatments, including radiotherapy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200919) and\/or surgery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200917), with a median interval of over five years from histopathological diagnosis to the start of chemotherapy. Temozolomide was most frequently used (64.5%). The objective response rate for all types of chemotherapy was 42%, with a median progression-free survival of 20 months and a median overall survival of 49 months. Adolescents and young adults (&lt;\u200940 years) showed significantly better survival outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Chemotherapy offers meaningful disease control in adolescents and young adults with irresectable symptomatic pilocytic astrocytoma, after prior treatments. However, with the improved efficacy and tolerability of targeted treatments, such as BRAF\/MEK inhibitors, treatment is shifting away from traditional chemotherapy and radiotherapy. Nevertheless, chemotherapy may still represent a viable treatment option in adolescent and young adults when no actionable molecular targets are identified or when targeted therapies have failed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-025-05275-8","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T06:57:25Z","timestamp":1760511445000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Chemotherapy in adult patients with pilocytic astrocytoma: a retrospective multicenter cohort study"],"prefix":"10.1007","volume":"176","author":[{"given":"Laura","family":"van den Berg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Wilbers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip Y. F. L.","family":"de Vos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathilde C. M.","family":"van Kouwenhoven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette Y. N. Schouten-van","family":"Meeteren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan A. F.","family":"Koekkoek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martinus P. G.","family":"Broen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Gijtenbeek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie E.","family":"Synhaeve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"van den Bent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacoline E. C.","family":"Bromberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Smits","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Taal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"issue":"12","key":"5275_CR1","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1038\/s41379-018-0103-x","volume":"31","author":"DN Palsgrove","year":"2018","unstructured":"Palsgrove DN et al (2018) Subependymal giant cell astrocytoma-like astrocytoma: a neoplasm with a distinct phenotype and frequent neurofibromatosis type-1-association. Mod Pathol 31(12):1787\u20131800","journal-title":"Mod Pathol"},{"issue":"2","key":"5275_CR2","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s11060-020-03653-y","volume":"151","author":"MW Parsons","year":"2021","unstructured":"Parsons MW et al (2021) The use and efficacy of chemotherapy and radiotherapy in children and adults with pilocytic Astrocytoma. J Neurooncol 151(2):93\u2013101","journal-title":"J Neurooncol"},{"issue":"2","key":"5275_CR3","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1007\/s00401-019-02088-8","volume":"139","author":"A Gareton","year":"2020","unstructured":"Gareton A et al (2020) The histomolecular criteria established for adult anaplastic pilocytic Astrocytoma are not applicable to the pediatric population. Acta Neuropathol 139(2):287\u2013303","journal-title":"Acta Neuropathol"},{"issue":"8","key":"5275_CR4","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1038\/ng.2682","volume":"45","author":"DT Jones","year":"2013","unstructured":"Jones DT et al (2013) Recurrent somatic alterations of FGFR1 and NTRK2 in pilocytic Astrocytoma. Nat Genet 45(8):927\u2013932","journal-title":"Nat Genet"},{"issue":"1","key":"5275_CR5","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/s40478-019-0801-8","volume":"7","author":"A Reinhardt","year":"2019","unstructured":"Reinhardt A et al (2019) Tumors diagnosed as cerebellar glioblastoma comprise distinct molecular entities. Acta Neuropathol Commun 7(1):163","journal-title":"Acta Neuropathol Commun"},{"issue":"2","key":"5275_CR6","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/s00401-018-1837-8","volume":"136","author":"A Reinhardt","year":"2018","unstructured":"Reinhardt A et al (2018) Anaplastic Astrocytoma with piloid features, a novel molecular class of IDH wildtype glioma with recurrent MAPK pathway, CDKN2A\/B and ATRX alterations. Acta Neuropathol 136(2):273\u2013291","journal-title":"Acta Neuropathol"},{"issue":"1","key":"5275_CR7","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1111\/bpa.12646","volume":"29","author":"FJ Rodriguez","year":"2019","unstructured":"Rodriguez FJ et al (2019) Alternative lengthening of telomeres, ATRX loss and H3-K27M mutations in histologically defined pilocytic Astrocytoma with anaplasia. Brain Pathol 29(1):126\u2013140","journal-title":"Brain Pathol"},{"issue":"2","key":"5275_CR8","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/PAS.0b013e3181c75238","volume":"34","author":"FJ Rodriguez","year":"2010","unstructured":"Rodriguez FJ et al (2010) Anaplasia in pilocytic Astrocytoma predicts aggressive behavior. Am J Surg Pathol 34(2):147\u2013160","journal-title":"Am J Surg Pathol"},{"issue":"suppl5","key":"5275_CR9","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/nox158","volume":"19","author":"QT Ostrom","year":"2017","unstructured":"Ostrom QT et al (2017) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the united States in 2010\u20132014. Neuro Oncol 19(suppl5):v1\u2013v88","journal-title":"Neuro Oncol"},{"issue":"12","key":"5275_CR10","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1177\/0883073820937225","volume":"35","author":"D Salles","year":"2020","unstructured":"Salles D et al (2020) Pilocytic astrocytoma: A review of General, Clinical, and molecular characteristics. J Child Neurol 35(12):852\u2013858","journal-title":"J Child Neurol"},{"key":"5275_CR11","doi-asserted-by":"crossref","unstructured":"Collins KL, Pollack IF (2020) Pediatric low-grade gliomas. Cancers (Basel) 12(5)","DOI":"10.3390\/cancers12051152"},{"issue":"6","key":"5275_CR12","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1148\/rg.246045146","volume":"24","author":"KK Koeller","year":"2004","unstructured":"Koeller KK, Rushing EJ (2004) From the archives of the AFIP: pilocytic astrocytoma: radiologic-pathologic correlation. Radiographics 24(6):1693\u20131708","journal-title":"Radiographics"},{"issue":"4","key":"5275_CR13","doi-asserted-by":"publisher","first-page":"221","DOI":"10.14791\/btrt.2022.0039","volume":"10","author":"YJ Lim","year":"2022","unstructured":"Lim YJ (2022) Medical treatment of pediatric Low-Grade glioma. Brain Tumor Res Treat 10(4):221\u2013225","journal-title":"Brain Tumor Res Treat"},{"issue":"6","key":"5275_CR14","doi-asserted-by":"publisher","first-page":"e315","DOI":"10.1016\/S1470-2045(17)30194-8","volume":"18","author":"M Weller","year":"2017","unstructured":"Weller M et al (2017) European association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol 18(6):e315\u2013e329","journal-title":"Lancet Oncol"},{"issue":"4","key":"5275_CR15","first-page":"199","volume":"2","author":"PD Brown","year":"2015","unstructured":"Brown PD et al (2015) Adult patients with supratentorial pilocytic astrocytoma: long-term follow-up of prospective multicenter clinical trial NCCTG-867251 (Alliance). Neurooncol Pract 2(4):199\u2013204","journal-title":"Neurooncol Pract"},{"issue":"12","key":"5275_CR16","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1056\/NEJMoa2303815","volume":"389","author":"E Bouffet","year":"2023","unstructured":"Bouffet E et al (2023) Dabrafenib plus Trametinib in pediatric glioma with BRAF V600 mutations. N Engl J Med 389(12):1108\u20131120","journal-title":"N Engl J Med"},{"issue":"7","key":"5275_CR17","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1016\/S1470-2045(19)30277-3","volume":"20","author":"J Fangusaro","year":"2019","unstructured":"Fangusaro J et al (2019) Selumetinib in paediatric patients with BRAF-aberrant or neurofibromatosis type 1-associated recurrent, refractory, or progressive low-grade glioma: a multicentre, phase 2 trial. Lancet Oncol 20(7):1011\u20131022","journal-title":"Lancet Oncol"},{"issue":"10","key":"5275_CR18","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1093\/neuonc\/nos202","volume":"14","author":"AK Gnekow","year":"2012","unstructured":"Gnekow AK et al (2012) Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German speaking society of pediatric oncology and hematology. Neuro Oncol 14(10):1265\u20131284","journal-title":"Neuro Oncol"},{"issue":"3","key":"5275_CR19","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1055\/a-1471-5897","volume":"231","author":"AK Gnekow","year":"2019","unstructured":"Gnekow AK et al (2019) SIOP-E-BTG and GPOH guidelines for diagnosis and treatment of children and adolescents with low grade glioma. Klin Padiatr 231(3):107\u2013135","journal-title":"Klin Padiatr"},{"issue":"1","key":"5275_CR20","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1038\/s41591-023-02668-y","volume":"30","author":"LB Kilburn","year":"2024","unstructured":"Kilburn LB et al (2024) The type II RAF inhibitor Tovorafenib in relapsed\/refractory pediatric low-grade glioma: the phase 2 FIREFLY-1 trial. Nat Med 30(1):207\u2013217","journal-title":"Nat Med"},{"issue":"2","key":"5275_CR21","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1177\/0883073816675547","volume":"32","author":"SA Upadhyaya","year":"2017","unstructured":"Upadhyaya SA et al (2017) Brainstem Low-Grade gliomas in Children-Excellent outcomes with multimodality therapy. J Child Neurol 32(2):194\u2013203","journal-title":"J Child Neurol"},{"issue":"6","key":"5275_CR22","doi-asserted-by":"publisher","first-page":"e305","DOI":"10.1016\/S1470-2045(20)30064-4","volume":"21","author":"J Fangusaro","year":"2020","unstructured":"Fangusaro J et al (2020) Response assessment in paediatric low-grade glioma: recommendations from the response assessment in pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol 21(6):e305\u2013e316","journal-title":"Lancet Oncol"},{"key":"5275_CR23","doi-asserted-by":"crossref","unstructured":"van den Bent MJ et al (2025) The use of minor response, volumetric assessment and growth rate kinetics as endpoints in grade 1\u20133 glioma clinical trials: a RANO perspective. Neuro Oncol","DOI":"10.1093\/neuonc\/noaf173"},{"issue":"1","key":"5275_CR24","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.ad.2019.05.009","volume":"112","author":"A Freites-Martinez","year":"2021","unstructured":"Freites-Martinez A et al (2021) Using the common terminology criteria for adverse events (CTCAE - Version 5.0) to evaluate the severity of adverse events of anticancer therapies. Actas Dermosifiliogr (Engl Ed) 112(1):90\u201392","journal-title":"Actas Dermosifiliogr (Engl Ed)"},{"key":"5275_CR25","doi-asserted-by":"publisher","first-page":"1587059","DOI":"10.3389\/fnins.2025.1587059","volume":"19","author":"T Patel","year":"2025","unstructured":"Patel T et al (2025) Long-term neurocognitive and behavioral outcomes in survivors of pediatric brain tumors: a systematic review. Front Neurosci 19:1587059","journal-title":"Front Neurosci"},{"issue":"1","key":"5275_CR26","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s12885-024-11820-x","volume":"24","author":"CM van Tilburg","year":"2024","unstructured":"van Tilburg CM et al (2024) LOGGIC\/FIREFLY-2: a phase 3, randomized trial of Tovorafenib vs. chemotherapy in pediatric and young adult patients with newly diagnosed low-grade glioma harboring an activating RAF alteration. BMC Cancer 24(1):147","journal-title":"BMC Cancer"},{"issue":"1","key":"5275_CR27","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1007\/s11060-023-04285-8","volume":"162","author":"L Bleeker","year":"2023","unstructured":"Bleeker L et al (2023) Medulloblastoma in adults: evaluation of the Dutch society for neuro-oncology treatment protocol. J Neurooncol 162(1):225\u2013235","journal-title":"J Neurooncol"}],"container-title":["Journal of Neuro-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-025-05275-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11060-025-05275-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-025-05275-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:34:14Z","timestamp":1767702854000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11060-025-05275-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["5275"],"URL":"https:\/\/doi.org\/10.1007\/s11060-025-05275-8","relation":{},"ISSN":["0167-594X","1573-7373"],"issn-type":[{"value":"0167-594X","type":"print"},{"value":"1573-7373","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]},"assertion":[{"value":"20 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Radboud University Medical Center.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all patients or, when applicable, from their legal guardians.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Nothing to disclose since no individual person\u2019s data will be published.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7"}}