Second surgery for recurrent pilocytic astrocytoma in children

Daniel C. Bowers, Timothy P. Krause, Leslie J. Aronson, Afsaneh Barzi, Peter C. Burger, Benjamin S. Carson, Jon D. Weingart, Moody D. Wharam, Elias R. Melhem, Kenneth J. Cohen

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Pilocytic astrocytoma (PA) is the most common childhood brain tumor. In cases where the tumor progresses or recurs following primary surgical resection, the appropriate treatment is unclear. Options include chemotherapy, radiation therapy, surgical resection or a combination thereof. To analyze the utility of further surgery, we performed a retrospective, single-institution review of pediatric patients with recurrent PAs from 1990 to 1999 who were treated with a second surgical resection. Patients were excluded if they received adjuvant chemotherapy or radiation therapy. Twenty cases were identified. Tumor locations included: cerebral hemisphere (3), cerebellum (7), optic pathway/hypothalamus (5), thalamus (1) and brainstem (4). The indication for 4 surgeries included an enlarging tumor-associated cyst. At second surgery, 10 of 20 patients had a gross total resection (GTR), 2 a near total resection (NTR), and the remaining 8 patients had a subtotal resection (STR). No patients have died. Two of 10 tumors after GTR, 0 of 2 tumors after NTR, and 7 of 8 tumors after STR had second recurrence/progression at a mean of 15 months (range 4-33 months) following second surgery. The remaining 11 patients are recurrence/progression-free at a mean of 40.7 months (range 19-119 months). Surgery for tumors or midline structures rarely resulted in a GTR (1 of 10 cases). Surgery for tumors located in the cerebral hemispheres or cerebellum resulted in GTR or NTR in all cases and can result in long periods of progression-free survival without further adjuvant treatment.

Original languageEnglish (US)
Pages (from-to)229-234
Number of pages6
JournalPediatric Neurosurgery
Volume34
Issue number5
DOIs
StatePublished - Jul 19 2001

Keywords

  • Astrocytoma, pilocytic
  • Glioma, low grade
  • Recurrence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology

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