Optic pathway hypothalamic gliomas in children under three years of age: The role of chemotherapy

Michele Madeira Silva, Stewart Goldman, Gesina Keating, Mary Anne Marymont, John Kalapurakal, Tadanori Tomita

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Objectives: Optic pathway/hypothalamic gliomas (OPHGs) tend to occur in young children. Treatment options consist of surgical resection, radiation therapy (RT) and chemotherapy. Due to complications induced by surgery and RT, chemotherapy has gained significant recognition for the treatment of OPHG in young children. Chemosensitivity of OPHG in very young children under 3 years of age has not been well documented. We analyzed 14 patients who were treated with chemotherapy with or without surgery. Materials and Methods: Fourteen children younger than 3 years (median age of 10 months) with OPHG were treated between 1988 and 1998. Magnetic resonance imaging was obtained in all cases. Hydrocephalus was present in 8 patients and diencephalic syndrome was noted in 6. Only 3 of these had evidence of neurofibromatosis-1. Five patients had partial tumor resection and 4 had endoscopic biopsy at the time of ventriculoperitoneal shunt placement. Pathological examination revealed low-grade astrocytoma in 5 and juvenile pilocytic astrocytoma in 4. All patients received chemotherapy: carboplatin in 8, a combination of carboplatin and vincristine in 4 and a combination of other agents in 2. Results: Eight (57%) of 14 patients had a sustained reduction of tumor during the follow-up time between 15 months and 8 years. The 5-year progression-free survival was 63%. These tumor reductions were often accompanied by clinical improvements. Diencephalic syndrome responded to chemotherapy alone in 4 of 6 patients. However, 5 others had progressive disease; 3 during the treatment and 2 following the treatment (9 months and 2 years, respectively). All these 5 patients had a partial tumor resection prior to chemotherapy. Conclusion: A majority of OPHGs responds to chemotherapy. Due to slow progression of these tumors and adverse effects of other therapeutic modalities, we recommend chemotherapy as a primary treatment for OPHGs. Our present data indicates that partial surgical resection does not enhance chemotherapy effectiveness for OPHGs in infants or children younger than 3 years. Copyright (C) 2000 S. Karger AG, Basel.

Original languageEnglish (US)
Pages (from-to)151-158
Number of pages8
JournalPediatric Neurosurgery
Volume33
Issue number3
StatePublished - 2000
Externally publishedYes

Fingerprint

Glioma
Drug Therapy
Carboplatin
Astrocytoma
Neoplasms
Radiotherapy
Therapeutics
Ventriculoperitoneal Shunt
Neurofibromatosis 1
Vincristine
Therapeutic Uses
Hydrocephalus
Disease-Free Survival
Magnetic Resonance Imaging
Biopsy

Keywords

  • Astrocytoma
  • Brain neoplasm
  • Chemotherapy
  • Chiasm
  • Hypothalamus
  • Optic nerve

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Silva, M. M., Goldman, S., Keating, G., Marymont, M. A., Kalapurakal, J., & Tomita, T. (2000). Optic pathway hypothalamic gliomas in children under three years of age: The role of chemotherapy. Pediatric Neurosurgery, 33(3), 151-158.

Optic pathway hypothalamic gliomas in children under three years of age : The role of chemotherapy. / Silva, Michele Madeira; Goldman, Stewart; Keating, Gesina; Marymont, Mary Anne; Kalapurakal, John; Tomita, Tadanori.

In: Pediatric Neurosurgery, Vol. 33, No. 3, 2000, p. 151-158.

Research output: Contribution to journalArticle

Silva, MM, Goldman, S, Keating, G, Marymont, MA, Kalapurakal, J & Tomita, T 2000, 'Optic pathway hypothalamic gliomas in children under three years of age: The role of chemotherapy', Pediatric Neurosurgery, vol. 33, no. 3, pp. 151-158.
Silva MM, Goldman S, Keating G, Marymont MA, Kalapurakal J, Tomita T. Optic pathway hypothalamic gliomas in children under three years of age: The role of chemotherapy. Pediatric Neurosurgery. 2000;33(3):151-158.
Silva, Michele Madeira ; Goldman, Stewart ; Keating, Gesina ; Marymont, Mary Anne ; Kalapurakal, John ; Tomita, Tadanori. / Optic pathway hypothalamic gliomas in children under three years of age : The role of chemotherapy. In: Pediatric Neurosurgery. 2000 ; Vol. 33, No. 3. pp. 151-158.
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T1 - Optic pathway hypothalamic gliomas in children under three years of age

T2 - The role of chemotherapy

AU - Silva, Michele Madeira

AU - Goldman, Stewart

AU - Keating, Gesina

AU - Marymont, Mary Anne

AU - Kalapurakal, John

AU - Tomita, Tadanori

PY - 2000

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N2 - Objectives: Optic pathway/hypothalamic gliomas (OPHGs) tend to occur in young children. Treatment options consist of surgical resection, radiation therapy (RT) and chemotherapy. Due to complications induced by surgery and RT, chemotherapy has gained significant recognition for the treatment of OPHG in young children. Chemosensitivity of OPHG in very young children under 3 years of age has not been well documented. We analyzed 14 patients who were treated with chemotherapy with or without surgery. Materials and Methods: Fourteen children younger than 3 years (median age of 10 months) with OPHG were treated between 1988 and 1998. Magnetic resonance imaging was obtained in all cases. Hydrocephalus was present in 8 patients and diencephalic syndrome was noted in 6. Only 3 of these had evidence of neurofibromatosis-1. Five patients had partial tumor resection and 4 had endoscopic biopsy at the time of ventriculoperitoneal shunt placement. Pathological examination revealed low-grade astrocytoma in 5 and juvenile pilocytic astrocytoma in 4. All patients received chemotherapy: carboplatin in 8, a combination of carboplatin and vincristine in 4 and a combination of other agents in 2. Results: Eight (57%) of 14 patients had a sustained reduction of tumor during the follow-up time between 15 months and 8 years. The 5-year progression-free survival was 63%. These tumor reductions were often accompanied by clinical improvements. Diencephalic syndrome responded to chemotherapy alone in 4 of 6 patients. However, 5 others had progressive disease; 3 during the treatment and 2 following the treatment (9 months and 2 years, respectively). All these 5 patients had a partial tumor resection prior to chemotherapy. Conclusion: A majority of OPHGs responds to chemotherapy. Due to slow progression of these tumors and adverse effects of other therapeutic modalities, we recommend chemotherapy as a primary treatment for OPHGs. Our present data indicates that partial surgical resection does not enhance chemotherapy effectiveness for OPHGs in infants or children younger than 3 years. Copyright (C) 2000 S. Karger AG, Basel.

AB - Objectives: Optic pathway/hypothalamic gliomas (OPHGs) tend to occur in young children. Treatment options consist of surgical resection, radiation therapy (RT) and chemotherapy. Due to complications induced by surgery and RT, chemotherapy has gained significant recognition for the treatment of OPHG in young children. Chemosensitivity of OPHG in very young children under 3 years of age has not been well documented. We analyzed 14 patients who were treated with chemotherapy with or without surgery. Materials and Methods: Fourteen children younger than 3 years (median age of 10 months) with OPHG were treated between 1988 and 1998. Magnetic resonance imaging was obtained in all cases. Hydrocephalus was present in 8 patients and diencephalic syndrome was noted in 6. Only 3 of these had evidence of neurofibromatosis-1. Five patients had partial tumor resection and 4 had endoscopic biopsy at the time of ventriculoperitoneal shunt placement. Pathological examination revealed low-grade astrocytoma in 5 and juvenile pilocytic astrocytoma in 4. All patients received chemotherapy: carboplatin in 8, a combination of carboplatin and vincristine in 4 and a combination of other agents in 2. Results: Eight (57%) of 14 patients had a sustained reduction of tumor during the follow-up time between 15 months and 8 years. The 5-year progression-free survival was 63%. These tumor reductions were often accompanied by clinical improvements. Diencephalic syndrome responded to chemotherapy alone in 4 of 6 patients. However, 5 others had progressive disease; 3 during the treatment and 2 following the treatment (9 months and 2 years, respectively). All these 5 patients had a partial tumor resection prior to chemotherapy. Conclusion: A majority of OPHGs responds to chemotherapy. Due to slow progression of these tumors and adverse effects of other therapeutic modalities, we recommend chemotherapy as a primary treatment for OPHGs. Our present data indicates that partial surgical resection does not enhance chemotherapy effectiveness for OPHGs in infants or children younger than 3 years. Copyright (C) 2000 S. Karger AG, Basel.

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