✓ Seventeen children with clinical evidence of a recurrent brain tumor were treated with vincristine 1.5 mg/sq m weekly for 12 weeks with doses on alternate weeks thereafter. Eight of the 16 patients who received four or more doses of vincristine showed significant objective responses; these included patients with high- and low-grade astrocytomas and patients with medulloblastoma. Six of the eight who responded remained asymptomatic for more than 2 years. The toxicity encountered was minimal except for seizures possibly related to vincristine in three children, who were able to resume treatment. Vincristine therapy results in long-term regression in a wide variety of pediatric brain tumors and causes little or no toxicity.
Jeffrey G. Rosenstock, Audrey E. Evans and Luis Schut
Isabelle L. Richmond and Charles B. Wilson
✓ This report describes a group of 25 children and adolescents with biopsy-proven pituitary adenomas. They were found in 33% of patients encountered in our recent study of 74 parasellar tumors detected in patients under 20 years old. Earlier detection accounts for this apparent increase in frequency. This interpretation is supported by the rarity of signs of intracranial hypertension at presentation, as well as decreased incidence and severity of visual failure. More than 70% of patients have evidence of pituitary hypersecretion at presentation. Increased awareness of these endocrinological signs as well as improved hormonal assays facilitate both diagnosis and management. Hypopituitarism is rare; the important exception is suppression of gonadotrophic function that is known to occur early in the natural history of intrasellar pituitary adenomas.
The low incidence of suprasellar and extrasellar extension is documented by both radiographic and operative findings. Transsphenoidal resection was employed in 92% of patients, with an estimated total resection in 73% of cases. Follow-up studies show a high quality of survival; no patient has severe neurological deficit and less than half of them require replacement therapy. The recurrence rate is 8%. Our findings do not support a previous report that pituitary adenomas in this age group are frequently extrasellar and invasive.
A preliminary report
Joan L. Venes, Sue McIntosh, Richard T. O'Brien and Allen D. Schwartz
✓ Eight consecutive children with biopsy-proven cerebellar medulloblastoma were treated with a combination of whole neuraxis radiation and prolonged chemotherapy using vincristine and cyclophosphamide. There was no evidence of tumor recurrence in the follow-up period, which ranged from 16 months to 7 years and 8 months following diagnosis. Morbidity associated with this regimen has been infrequent and easily reversible.
Dorcas S. Fulton, Victor A. Levin, William M. Wara, Michael S. Edwards and Charles B. Wilson
. Neurology 8 : 1 – 7 , 1958 Bray PF, Carter S, Taveras JM: Brainstem tumors in children. Neurology 8: 1–7, 1958 3. Crafts DC , Wilson CB : Current status of pediatric brain tumor chemotherapy , in O'Brien MS (ed): Pediatric Neurological Surgery. New York : Raven Press , 1978 , pp 87 – 100 Crafts DC, Wilson CB: Current status of pediatric brain tumor chemotherapy, in O'Brien MS (ed): Pediatric Neurological Surgery. New York: Raven Press, 1978, pp 87–100 4. Gehan EA . A generalized
Lester E. Wold and Edward R. Laws Jr.
✓ A series of 12 surgically treated and pathologically proven cranial chordomas presenting in children and young adults is reviewed. These rare tumors occur in relation to the path of the primitive notochord; four were parasellar, six were mid-clival, and two were inferior clival in location. Pathological evaluation revealed five of the tumors to have a significant chondroid component. Follow-up studies ranging from 1 month to 21 years revealed that eight patients were alive, all of whom had received radiation therapy following surgery.
Gary L. Rea, Robert D. Akerson, Gaylan L. Rockswold and Stephen A. Smith
✓ Subependymomas are extremely rare tumors in the pediatric population and, when they occur, they are usually of a mixed type with elements of subependymoma and ependymoma. This report is of a 2½-year-old male infant with a pure subependymoma of the fourth ventricle.
Results of treatment with radiation therapy and chemotherapy
Surasak Phuphanich, Michael S. B. Edwards, Victor A. Levin, Pamela S. Vestnys, William M. Wara, Richard L. Davis and Charles B. Wilson
B rain tumors are the most common solid tumors in the pediatric age group, with an incidence of approximately 2.5 per 100,000 children under 16 years of age; they also account for 16% of all cancer in children. 2, 27 Gliomas, in particular supratentorial gliomas, 11, 13, 21 account for 60% of primary pediatric brain tumors 4 and have the highest rate of recurrence. The natural history of this disease in children is a steady progression to death, with a median survival time of less than 45 weeks. 6 While the relationship between prognosis and histology and
Its contributions to neurosurgical diagnosis
Jose M. Bonnin and Lucien J. Rubinstein
Neuropathol 60: 271–277,1983 77. Nakamura Y , Becker LE , Marks A : Distribution of immunoreactive S-100 protein in pediatric brain tumors. J Neuropathol Exp Neurol 43 : 136 – 145 , 1983 Nakamura Y, Becker LE, Marks A: Distribution of immunoreactive S-100 protein in pediatric brain tumors. J Neuropathol Exp Neurol 43: 136–145, 1983 78. Nakane PK : Classifications of anterior pituitary cell types with immunoenzyme histochemistry. J Histochem Cytochem 18 : 9 – 20 , 1970 Nakane PK
Dennis E. Bullard and Darell D. Bigner
CNS. The patients' age at onset and the poor prognosis make the economic and personal impact of these tumors far greater than numbers alone would indicate, ranking fourth among males and eighth among females in the order of neoplastic causes for lost work years. 126 Malignant gliomas, which are the most commonly occurring primary CNS tumors in adults (representing between 15% and 40% of all intracranial neoplasms) and medulloblastomas (which account for one-fourth of all pediatric brain tumors) 27, 61, 166 are, in large part, responsible for this situation. 27, 51
Masakazu Takayasu, Masato Shibuya, Masahiko Kanamori, Yoshio Suzuki, Koichiro Ogura, Naoki Kageyama, Hayato Umekawa and Hiroyoshi Hidaka
191: 523–531, 1980 21. Nakamura Y , Becker LE , Marks A : Distribution of immunoreactive S-100 protein in pediatric brain tumors. J Neuropathol Exp Neurol 42 : 136 – 145 , 1983 Nakamura Y, Becker LE, Marks A: Distribution of immunoreactive S-100 protein in pediatric brain tumors. J Neuropathol Exp Neurol 42: 136–145, 1983 22. Schanne FAX , Kane AB , Young EE , et al : Calcium dependence of toxic cell death: a final common pathway. Science 206 : 700 – 702 , 1979