Application of preoperative chemotherapy in pediatric brain maligant tumors patients

Abstract

Objective To investigate the indication and significance of preoperative chemotherapy for pediatric patients with brain malignant tumors. Methods and Results The clinical data of 9 pediatric patients with brain malignant tumors who were admitted to Department of Neurosurgery, Tsinghua University Yuquan Hospital from January 2017 to August 2019 were retrospectively analyzed. The patients were 6 males and 3 females, aged from 1.50 months to 6 years. Among the 9 cases, 5 cases were located in the pineal region, one case in the third ventricle, one case in the frontotemporal and the basal ganglia region and 2 cases in the fourth ventricle. The preoperative clinical diagnosis of the 9 patients included 5 cases of germ cell tumor, 2 cases of medulloblastoma, one case of pineal blastoma and one case of embryonal tumor. Before the chemotherapy, 6 patients were treated with ventriculo⁃peritoneat shunt, 2 patients with ventricular puncture and external drainage, and one patient with endoscopic third ventriculostomy. Before surgery, 2 cases were given carboplatin+etoposide regimen, 4 cases were given cisplatin+etoposide regimen, one case was given carboplatin+etoposide+isophoramide regimen, and 2 cases were given cisplatin+etoposide+isophoramide regimen. 6 patients received one cycle of chemotherapy before tumor resection, 2 patients received 2 cycles and one patient received 3 cycles. All of the patients received tumor resection after 1-3 cycles of chemotherapy. The following treatments were depended on the pathological results. After preoperative chemotherapy, tumors' volume decreased in 7 cases while increased in one case. Additionally, there was one case of tumor apoplexy. The blood supply of tumors of all the 9 patients was not abundant. Among the 9 cases, total removal was achieved in 8 cases and subtotal in one case. The pathological results revealed 3 germ cell tumors, 2 pineoblastomas, 2 medulloblastomas, one diffuse midline glioma, and one atypical teratomoid/rhabdomyoid tumor (AT/RT). The 9 patients were followed up from 8 to 38 months (mean 18 months). Three patients died of tumor recurrence and there were no tumor recurrences in the other 6 patients. Conclusions Preoperative chemotherapy may be considered for children with brain malignant tumors which are clinically sensitive to chemotherapy at high risk of surgery. Preoperative chemotherapy for brain tumors in infants and young children was effective in reduction of tumor volume and vascularity, which significantly facilitated maximal tumor resection.

Keywords

• brain neoplasms
• drug therapy
• neurosurgical procedures
• child