title: 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.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Osawa
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
authors.forename: Ryuta
authors.initials: R
authors.lastname: Saito
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Niizuma
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000627:therapeutic use; D004317:Doxorubicin / Q000031:analogs & derivatives / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D007223:Infant; D015192:Infratentorial Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D000077146:Irinotecan; D008558:Melphalan / Q000627:therapeutic use; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy; D009447:Neuroblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D013852:Thiotepa / Q000627:therapeutic use; D019772:Topotecan / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D000077146:Irinotecan; D019772:Topotecan; D004317:Doxorubicin; D013852:Thiotepa; D016190:Carboplatin; C027260:pirarubicin; D002945:Cisplatin; D008558:Melphalan; D007069:Ifosfamide; D002166:Camptothecin