title: Complete surgical resection in children with low-grade astrocytomas after neoadjuvant chemotherapy.
abstract: 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.
authors.affiliation: 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
authors.forename: Elvis Terci
authors.initials: ET
authors.lastname: Valera
authors.forename: Luciano Neder
authors.initials: LN
authors.lastname: Serafini
authors.forename: Hélio Rubens
authors.initials: HR
authors.lastname: Machado
authors.forename: Luiz Gonzaga
authors.initials: LG
authors.lastname: Tone
mesh_terms: 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