Current Treatment Approaches for Infants with Malignant Central Nervous System Tumors

Lafay‐Cousin, Lucie; Strother, Douglas

doi:10.1634/theoncologist.2008-0193

Cited by 56 publications

(50 citation statements)

References 110 publications

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“…6 On the other hand, brain tumors in infants and young children are frequently large and highly vascular, and complete resection is often difficult due to the risks of neurological complications and excessive blood loss. Relatively small circulating blood volume in infants and young children lowers the threshold of tolerance for intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

“…While more extensive resection has been demonstrated to correlate with improved outcomes in most brain tumors in infants and young children, complete resection is often challenging due to the risks of neurological complications and excessive blood loss. 2,4,6 In such cases, neoadjuvant chemotherapy may reduce the size and/or the vascularity of the tumor, facilitate maximal tumor resection, and contribute to improving outcomes. 5,9 We retrospectively analyzed the intraoperative blood loss, extent of resection, neurological complications, and outcomes after secondlook surgery following neoadjuvant chemotherapy in 9 patients with brain tumors.…”

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confidence: 99%

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Neoadjuvant chemotherapy for brain tumors in infants and young children

Iwama¹,

Ogiwara²,

Kiyotani³

et al. 2015

PED

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OBJECT Because of their large size and high vascularity, complete removal of brain tumors in infants and young children is often difficult. In most cases the degree of resection is associated with prognosis. Neoadjuvant chemotherapy may facilitate resection by reducing the vascularity of the tumor. The authors evaluated the effectiveness of neoadjuvant chemotherapy in the management of these tumors. METHODS The authors performed a retrospective review of infants and young children who underwent tumor removal after neoadjuvant chemotherapy. RESULTS Nine consecutive patients underwent resection after neoadjuvant chemotherapy during the period February 2004 to December 2012. The mean age at diagnosis was 18 months (range 2–50 months). The average largest tumor diameter was 71 mm (range 30–130 mm) at initial surgery. Five patients underwent partial resection, and 4 underwent biopsy as the initial surgery. The histopathological diagnoses were ependymoma in 2 patients, anaplastic ependymoma in 1, primitive neuroectodermal tumor (PNET) in 2, choroid plexus carcinoma in 1, atypical teratoid/rhabdoid tumor (AT/RT) in 1, glioblastoma in 1, and embryonal tumor with abundant neuropil and true rosettes in 1. After 2–4 courses of multiagent chemotherapy (mainly with vincristine, cyclophosphamide, etoposide, and cisplatin), the second-look surgery was performed. In 1 patient with a PNET, intratumoral hemorrhage was observed after 2 courses of chemotherapy. The mean interval between the initial and the second-look surgery was 3 months. The tumor volume was reduced to varying degrees in 5 patients (56%) after chemotherapy. Intraoperatively, the vascularity of the tumor was considerably reduced, and the tumor was more circumscribed in all cases. Gross-total resection was achieved in 8 patients (89%) and neartotal resection in 1 (11%). Histopathological examination demonstrated fibrotic tissue circumscribing the tumor in 6 of 9 cases (67%). The average blood loss was 20% of the estimated blood volume, and 3 patients (33%) required a blood transfusion. There was no surgical mortality. One patient had transient dysphasia postoperatively. The mean follow-up period was 28 months. At the last follow-up, 2 patients (22%) had died (1 died of tumor progression and 1 of sepsis), and 4 patients (44%) had no tumor recurrence. CONCLUSIONS Neoadjuvant chemotherapy for brain tumors in infants and young children was effective in reduction of tumor vascularity and clarification of the tumor-brain interface, which significantly facilitated maximal tumor resection.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Neoadjuvant chemotherapy for brain tumors in infants and young children

Iwama¹,

Ogiwara²,

Kiyotani³

et al. 2015

PED

View full text Add to dashboard Cite

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“…Not surprisingly, the results are extremely variable in the absence of a standard protocol and superiority of one treatment modality over another. Strategies like ‘HTT-SKK' (use of high-dose systemic methotrexate with intraventricular methotrexate), high-dose myeloablative chemotherapy with autologous stem cell rescue, low-dose radiation with a tumor bed boost, or use of conformal RT have been employed to avoid the adverse effects of conventional RT [17]. …”

Section: Discussionmentioning

confidence: 99%

Brain Tumors of Infancy - An Institutional Experience and Review of the Literature

2013

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Introduction: Brain tumors in infants are rare and form a distinct subgroup of pediatric brain tumors. These tumors differ from tumors in older children with respect to histology and management and tend to have a poorer outcome. Methods: We analyzed 31 consecutive cases of brain tumors in infancy managed in our institute in the last 15 years and reviewed the published literature since 1990. Results: Only 2 of these patients had congenital tumors. Choroid plexus tumors were the most common histological subtype, followed by medulloblastoma; 62% of patients underwent a gross total or near-total excision of the tumor with 1 perioperative mortality; 68% of patients had a good outcome. Conclusion: Choroid plexus tumors were the most common histological type. Safe resection should be the goal of surgery. Surgeries for tumors in this age group were associated with lower rates of total excision and higher morbidity. Low-grade lesions as expected are associated with longer survival; however, long-term outcomes are far from satisfactory.

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“…Based on current literature, however, it is clearly shown that cytoreductive surgery with neoadjuvant chemotherapy and stem cell support produces some of the best outcomes in the treatment of intracranial pediatric malignancies. 7,14 Recent reports have confirmed the utility of gross-total resection of pediatric tumors subsequent to chemotherapy. 24 In this situation, it is not clear what the implications would have been if the errant tumor was left in the ventricle.…”

Section: 13mentioning

confidence: 95%

Endoscopic removal of an intraventricular primitive neuroectodermal tumor: retrieval of a free-floating fragment using a urological basket retriever

Carr

Zuckerman

Tomycz

et al. 2013

PED

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The endoscopic resection of intraventricular tumors represents a unique challenge to the neurological surgeon. These neoplasms are invested deep within the brain parenchyma and are situated among neurologically vital structures. Additionally, the cerebrospinal fluid system presents a dynamic pathway for resected tumors to be mobilized and entrapped in other regions of the brain. In 2011, the authors treated a 3-year-old girl with a third ventricular mass identified on stereotactic brain biopsy as a WHO Grade IV CNS primitive neuroectodermal tumor. After successful neoadjuvant chemotherapy, endoscopic resection was performed. Despite successful resection of the tumor, the operation was complicated by mobilization of the resected tumor and entrapment in the atrial horn of the lateral ventricle. Using a urological stone basket retriever, the authors were able to retrieve the intact tumor without additional complications. The flexibility afforded by the nitinol urological stone basket was useful in the endoscopic removal of a free-floating intraventricular tumor. This device may prove to be useful for other practitioners performing these complicated intraventricular resections.

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Current Treatment Approaches for Infants with Malignant Central Nervous System Tumors

Cited by 56 publications

References 110 publications

Neoadjuvant chemotherapy for brain tumors in infants and young children

Neoadjuvant chemotherapy for brain tumors in infants and young children

Brain Tumors of Infancy - An Institutional Experience and Review of the Literature

Endoscopic removal of an intraventricular primitive neuroectodermal tumor: retrieval of a free-floating fragment using a urological basket retriever

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