Second surgery for recurrent pilocytic astrocytoma in children

Pilocytic astrocytoma (PA) is the most common childhood brain tumor. In cas es where the tumor progresses or recurs following primary surgical resectio n, the appropriate treatment is unclear. Options include chemotherapy, radi ation therapy, surgical resection or a combination thereof. To analyze the utility of further surgery, we performed a retrospective, single-institutio n review of pediatric patients with recurrent PAs from 1990 to 1999 who wer e treated with a second surgical resection. Patients were excluded if they received adjuvant chemotherapy or radiation therapy. Twenty cases were iden tified. Tumor locations included: cerebral hemisphere (3), cerebellum (7), optic pathway/hypothalamus (5), thalamus (1) and brainstem (4). The indicat ion 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 tota l resection (NTR), and the remaining 8 patients had a subtotal resection (S TR). 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 m ean of 15 months (range 4-33 months) following second surgery. The remainin g 11 patients are recurrence/progression-free at a mean of 40.7 months (ran ge 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 hemis pheres or cerebellum resulted in GTR or NTR in all cases and can result in long periods of progression-free survival without further adjuvant treatmen t. Copyright (C) 2001 S. Karger AG, Basel.