Pediatric papillary tumors of the pineal region: to observe or to treat following gross total resection?

Abstract

We present the case of a 3-year-old girl diagnosed with PTPR. Due to her young age, adjuvant radiotherapy was omitted after gross total tumor resection. Thirty-six months later, local tumor recurrence occurred. Considering the possible risks of secondary surgery, the recurrent tumor was irradiated with proton radiotherapy. Three months later, the tumor showed near-complete remission. DISCUS-SION: Based on this experience and other pediatric case reports from the literature, local radiotherapy might be suggested also after complete tumor resection. Originally published at: Abela, Lucia; Rushing, Elisabeth Jane; Ares, Carmen; Scheer, Ianina; Bozinov, Oliver; Boltshauser, Eugen; Grotzer, Michael A (2013). Pediatric papillary tumors of the pineal region: to observe or to treat following gross total resection? Child's Nervous System, 29 (2) Based on this experience and other pediatric case reports from the literature, local radiotherapy might be suggested also after complete tumor resection.

Papillary tumor of the pineal region. Report of two cases and literature review

“…On the other hand, tumor regression after radiotherapy [10,32] or even tumor disappearance [33] was observed. Whole brain irradiation, local radiotherapy, gamma knife surgery, stereotactic linac radiosurgery were all used with different protocols [32,34,35].…”

“…PTPR is a pineal tumor encountered both in adults and in children [10][11][12][13]. The average age of patients is 32-34 years [ 4,14].…”

Papillary Tumor of the Pineal Region in Children: Presentation of a Case and Comprehensive Literature Review

“…Concurrently, those cases did not recur during 3, 12, and 15 months of follow up. [10][11][12]22,23,[32][33][34][35][36][37] Summarizing our results, 17 out of 20 pediatric patients in the literature had follow-up information, and a gross total resection was achieved in 15 of them along the course of the disease. Only one of the two patients with partial resection had a non-recurrent stable disease.. Four of the 8 patients who presented a local recurrence/regrowth during the follow-up, had a second recurrence (3 local recurrences, and one spinal and ventricular recurrence).…”

“…11,22 Table 1 lists the published cases. [10][11][12]22,23,[32][33][34][35][36][37] We found 19 cases in children younger than 17 years old. Although some information was not available in this small population of cases, some conclusions from all 20 patients could be outlined.…”

“…The unique patient with spinal disease died. [10][11][12]22,23,[32][33][34][35][36][37] Compared to the epidemiology in the general population, where 68% of PTPR recurred in a mean follow up of 4.2 years (with an overall survival of 73% at 5 years, and 58% at 10 years), in children population only the 47% of PTPR recurred in a mean follow up of 6,5 years. 11 The survival rate of the entire children group was 94% with only one dead patient 5 years after starting the treatment.…”