Complete surgical resection in children with low-grade astrocytomas after neoadjuvant chemotherapy

Introduction: Low-grade astrocytomas constitute the majority of pediatric central nervous system neoplasms. Gross total resection is desirable as the initial therapeutic approach and is curative in most cases. In the past, radiation therapy was often recommended for patients in whom complete resection was not achieved, although there are special concerns about secondary malignancy and cognitive impairment. There has been increasing interest in the use of chemotherapy to treat these tumors, but appropriate indications still need to be defined. Case reports: The use of neoadjuvant chemotherapy to ease surgical resection in two children with inoperable pilocytic astrocytomas who presented with extrinsic compression of mesencephalic structures is described. Discussion: This paper also emphasizes and discusses the therapeutic approach for very selected cases of low-grade gliomas in children presenting with inoperable giant lesions, in whom the use of chemotherapy may be considered initially.