Intraoperative Radiation Therapy and Chemotherapy for Huge Choroid Plexus Carcinoma in an Infant —Case Report—

Abstract

A 2-month-old boy presented with a huge choroid plexus carcinoma in the left cerebral hemisphere. Almost total resection of the tumor was achieved, but a remnant abruptly enlarged 5 months later, re quiring reoperation.After radical resection of the tumor, intraoperative radiation (10 Gy) was de livered. Postoperative chemotherapy was performed with methotrexate and vincristine, selected on the basis of in vitro chemosensitivity testing. No recurrence of the tumor was detected 18 months after the second operation. Radical surgery with these adjuvant therapies may be a good method to control this aggressive disease in infants.

Pediatric choroid plexus tumors: epidemiology, treatments, and outcome analysis on 202 children from the SEER database

“…The utilization of radiation treatment found in our study was similar to what has been described in the literature [21,[27][28][29][30][31][32]. Radiation was used much more frequently in CPCs than CPPs (16 % versus 0.9 %, respectively), and much more commonly in children over 4 years of age with CPCs than younger children with CPCs (47.8 versus 5.7 %).…”

“…Several reports have described survival benefits of radiation therapy for CPCs [27,28,30,32]. A meta-analysis by Wolff and colleagues found a 5-year projected survival of 68 % for patients treated with radiation versus 16 % for those that were not [32].…”

“…Also, in terms of deciphering the best treatment strategies for CPTs, in particular for CPCs, another important limitation of SEER is that chemotherapy utilization data is not included [6,7]. Indeed, chemotherapy has become a frequently used adjuvant therapy for sub-totally resected CPC, or neo-adjuvant therapy prior to surgery [10,12,20,30,[37][38][39][40]. Furthermore, we defined ''extent of resection'' based on the surgical codes provided by SEER that are most in keeping with GTR (i.e., ''Radical, total, gross resection'', ''resection of lobe of brain'', ''Gross total resection of lobe of brain''), and STR (i.e., ''Local excision'', ''excisional biopsy'', or, ''Subtotal resection'').…”

“…The extent of surgical resection was divided into 4 groups: subtotal resection (STR), gross total resection (GTR), surgery-not otherwise specified (NOS), and no surgery. The STR group included patients with surgical codes 20 (Local excision of tumor, lesion, or mass, excisional biopsy, or stereotactic biopsy of the brain) and 21 (Subtotal resection of tumor, lesion or mass in brain), while the GTR group included patients with surgical codes 30 (Radical, total, gross resection of tumor, lesion or mass in brain), 40 (Partial resection of lobe of brain, when the surgery cannot be coded as [20][21][22][23][24][25][26][27][28][29][30], and 55 (Gross total resection of lobe of brain (lobectomy)). ''Surgery, NOS'' included patients with surgical code 90 (Surgery, NOS).…”

Massive blood transfusion in choroid plexus tumor surgery: 10-years' experience

“…blood volume (range, 5%-524%; 2 deaths from exsanguinating hemorrhage) by Due-Tonnesen et al [17]; no fatalities but intraoperative blood loss of 15% to 63.8% (mean, 13.8%) in 11 CPCs operated on by St Clair et al [18]. Cases of intraoperative deaths from excessive bleeding have been reported in the last decades [19][20][21][22]. Interestingly, Shinoda et al [20] described postoperative massive bleeding leading to death (suggesting a DIC complication) in a 6-month-old infant affected by CPC.…”