Complete surgical resection in children with low-grade astrocytomas after neoadjuvant chemotherapy.
BACKGROUND
Low-grade astrocytomas constitute the majority of pediatric central nervous system neoplasms. Gross total resection is desirable as the initial therapeutic approach and is curative in most cases. In the past, radiation therapy was often recommended for patients in whom complete resection was not achieved, although there are special concerns about secondary malignancy and cognitive impairment. There has been increasing interest in the use of chemotherapy to treat these tumors, but appropriate indications still need to be defined.


METHODS
The use of neoadjuvant chemotherapy to ease surgical resection in two children with inoperable pilocytic astrocytomas who presented with extrinsic compression of mesencephalic structures is described.


CONCLUSIONS
This paper also emphasizes and discusses the therapeutic approach for very selected cases of low-grade gliomas in children presenting with inoperable giant lesions, in whom the use of chemotherapy may be considered initially.
Valera
Elvis Terci
ET
Pediatric Department, University Hospital, School of Medicine, University of São Paulo, Av Bandeirantes, 3900-Monte Alegre, 14049-900, Ribeirão Preto, São Paulo, Brazil. elvisvalera@hotmail.com
Serafini
Luciano Neder
LN
Machado
Hélio Rubens
HR
Tone
Luiz Gonzaga
LG
D001254:Astrocytoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020360:Neoadjuvant Therapy; D011379:Prognosis; D013702:Temporal Lobe / Q000473:pathology; D016896:Treatment Outcome