Infratentorial brain metastases of pediatric non-epithelial malignant tumors: three case reports

Abstract

Three pediatric patients with infratentorial metastatic non-epithelial malignant brain tumors were successfully treated by radical surgical resection followed by aggressive radiochemotherapy. One patient with neuroblastoma and two with rhabdomyosarcoma were successfully treated by first line multimodal treatments, but developed infratentorial metastasis after several months of remission. All patients revealed intracranial metastases manifesting as rapidly progressing neurological symptoms caused by mass effect in the posterior fossa. Radical surgical resection was performed without morbidity. The patients were then treated by adjuvant radiochemotherapy with or without autologous peripheral blood stem cell transplantation, resulting in complete remission. Two patients developed extracranial recurrences 4 months after the treatments for intracranial metastases. One patient was treated by second high-dose chemotherapy with allogeneic cord blood transplantation, again resulting in complete remission. Another patient was treated by second chemotherapy and maintaining stable disease. The other patient maintained complete remission. All three patients were alive without neurological deficit for 8, 11, and 12 months after diagnosis of brain metastasis. Patients with infratentorial brain metastases of highly malignant pediatric non-epithelial tumors are in a severe clinical state, but still can have longer and useful lives with aggressive multimodal treatments combined with radical surgical resection.

Brain Metastasis in Bone and Soft Tissue Cancers: A Review of Incidence, Interventions, and Outcomes

“…They found that CNS prophylactic chemotherapy and higher doses of RT resulted in a better ability to achieve persistent local tumor control. As shown in Table 5, previously reported cases of RMS with BM [2, 3, 15, 17, 33, 35, 68, 83–85, 88, 90, 91] have an average age of 12.0 years, with majority being males (21, 56.8%). Most were children (89.2%) including 5 neonates.…”

“…In a Japanese study with 480 sarcoma patients [88], 2 of the 13 with metastatic RMS had BM (15.4%). Parasuraman et al [35] documented patients treated at St. Jude Children's Hospital from 1962 to 1998 with BM from RMS.…”

“…Patients with a history of metastasis have a significant risk of future BM [3]. Surgical treatment for select patients can result in long-term survival [87, 88], and increasing doses and volume of RT have been shown to prolong survival [86]. Overall, a combined modality approach is advocated.…”

“…Alveolar soft part sarcomas (ASPS) account for a small percentage of STS at roughly 1% [88, 89]. In contrast to bone-part tumors, ASPS is a soft-part tumor that presents mainly in muscle and deep soft tissue of the thigh or leg [130–133].…”

Brain metastasis in children with stage 4 neuroblastoma after multidisciplinary treatment

“…Relapsed neuroblastoma metastasizes to the CNS as one cause of death. The overall incidence of brain metastasis in neuroblastoma after treatment ranges from 1.7% to 11.7% [ 3 ].…”