Child's Nervous System

, Volume 21, Issue 6, pp 477–481 | Cite as

Management of pilocytic astrocytoma with diffuse leptomeningeal spread: two cases and review of the literature

  • Henry E. Aryan
  • Hal S. Meltzer
  • Daniel C. Lu
  • Burak M. Ozgur
  • Michael L. Levy
  • Derek A. Bruce
Case Report

Abstract

Introduction

Leptomeningeal dissemination of juvenile pilocytic astrocytoma (JPA) is a rare event. We report two children with disseminated JPAs treated with a chemotherapeutic agent, temozolomide, after progression of the disease despite surgery, traditional chemotherapy, and/or radiation therapy.

Case reports

Patient 1 presented with hydrocephalus and progressive lower extremity weakness, and was found to have a suprasellar mass as well as extensive spinal disease. Ventriculoperitoneal shunting, decompressive laminectomy with spinal tumor debulking, and chemotherapy with carboplatin and vincristine were initially employed. However, disease progressed and craniospinal irradiation and temozolomide were used. Patient 1 remains in a fair condition today, 2 years later. Patient 2 presented at 8 months of age with failure to thrive. Imaging revealed a cystic lesion in the hypothalamic region with extensive subarachnoid metastatic disease to the spine. Biopsy was performed followed by chemotherapy with vincristine, cyclohexylchloroethylnitrosourea (CCNU), 6-TG, and procarbazine. Due to the continued progression of the disease, cytoreductive surgery was performed and her chemotherapeutic regimen was switched to temozolomide. Two years after initial presentation patient 2 is clinically much improved with stable residual disease.

Discussion

We review the literature and discuss treatment strategies for this challenging disease.

Keywords

Pilocytic astrocytoma Leptomeningeal spread Metastasis 

References

  1. 1.
    Abrey LE, Olson JD, Raizer JJ et al (2001) A phase II trial of temozolomide for patients with recurrent or progressive brain metastases. J Neurooncol 53:259–265CrossRefPubMedGoogle Scholar
  2. 2.
    Akiyama Y, Jung S, Salhia B et al (2001) Hyaluronate receptors mediating glioma cell migration and proliferation. J Neurooncol 94:80–89Google Scholar
  3. 3.
    Auer RN, Rice GPA, Hinton GG et al (1981) Cerebellar astrocytoma with benign histology and malignant clinical course. J Neurosurg 54:128–132PubMedGoogle Scholar
  4. 4.
    Brada M, Hoang-Xuan K, Ramping R et al (2001) Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol 12:259–266CrossRefPubMedGoogle Scholar
  5. 5.
    Brown MT, Friedman HS, Oakes WJ et al (1993) Chemotherapy for pilocytic astrocytomas. Cancer 71:3165–3172PubMedGoogle Scholar
  6. 6.
    Burder PC, Scheithauer BW, Vogel FS (1991) Surgical pathology of the nervous system and its coverings, 3rd edn. Churchill Livingstone, New York, pp 193–437Google Scholar
  7. 7.
    Civitello LA, Packer RJ, Rorke LB et al (1988) Leptomeningeal dissemination of low grade gliomas in childhood. Neurology 38:562–566PubMedGoogle Scholar
  8. 8.
    Cohen ME, Mahoney DH, Duffner PK et al (1994) Evaluation of optic pathway tumors: natural history and treatment. Pediatric Oncology Group (POG). Neurology 36:505Google Scholar
  9. 9.
    Dirks PB, Jay V, Becker LE et al (1994) Development of anaplastic changes in low-grade astrocytomas of childhood. Neurosurgery 34:68–78PubMedGoogle Scholar
  10. 10.
    Dirven CM, Mooij JJ, Molenaar WM (1997) Cerebellar pilocytic astrocytoma: a treatment protocol based upon analysis of 73 cases and a review of the literature. Childs Nerv Syst 13:17–23CrossRefPubMedGoogle Scholar
  11. 11.
    Jamjoom AB, Jamjoom ZA, Al-Rayess M (1998) Intraventricular and leptomeningeal dissemination of a pilocytic cerebellar astrocytoma in a child with a ventriculoperitoneal shunt: case report. Br J Neurosurg 12:56–58CrossRefPubMedGoogle Scholar
  12. 12.
    Kayama T, Tominaga T, Yoshimoto T (1996) Management of pilocytic astrocytoma. Neurosurg Rev 19:217–220PubMedGoogle Scholar
  13. 13.
    Kleihues P, Cavanee WK (2000) World Health Organization classification of tumors: tumors of the nervous system. IARC, LyonGoogle Scholar
  14. 14.
    Mamelak AN, Prados MD, Obana WG (1994) Treatment options and prognosis for multicentric juvenile pilocytic astrocytoma. J Neurosurg 81:24–30PubMedGoogle Scholar
  15. 15.
    Mishima K, Nakamura M, Nakamura H et al (1992) Leptomeningeal dissemination of cerebellar pilocytic astrocytoma: case report. J Neurosurg 77:788–791PubMedGoogle Scholar
  16. 16.
    Moghrabi A, Friedman HS, Burger PC et al (1993) Carboplatin treatment of progressive optic pathway gliomas to delay radiotherapy. J Neurosurg 79:223–227PubMedGoogle Scholar
  17. 17.
    Morikawa M, Tamaki N, Kokunai T et al (1997) Cerebellar pilocytic astrocytoma with leptomeningeal dissemination: case report. Surg Neurol 48:49–52CrossRefPubMedGoogle Scholar
  18. 18.
    Nishio S, Takeshita I, Fukui M et al (1988) Anaplastic evolution of childhood optico-hypothalamic pilocytic astrocytoma: report of an autopsy case. Clin Neuropathol 7:254–258PubMedGoogle Scholar
  19. 19.
    Nishio S, Takeshita I, Fujiwara S et al (1993) Optico-hypothalamic glioma: an analysis of 16 cases. Childs Nerv Syst 9:334–338PubMedGoogle Scholar
  20. 20.
    Nishio S, Morioka T, Takeshita I et al (1995) Chemotherapy for progressive pilocytic astrocytomas in the chiasmo-hypothalamic regions. Clin Neurol Neurosurg 97:300–306CrossRefPubMedGoogle Scholar
  21. 21.
    Obana WG, Cogen PH, Davis RL et al (1991) Metastatic juvenile pilocytic astrocytoma: case report. J Neurosurg 75:972–975PubMedGoogle Scholar
  22. 22.
    Osoba D, Brada M, Yung WKA et al (2000) Health-related quality of life in patients with anaplastic astrocytoma during treatment with temozolomide. Eur J Cancer 36:1788–1795CrossRefPubMedGoogle Scholar
  23. 23.
    Oxenhandler DC, Sayers MP (1978) The dilemma of childhood optic gliomas. J Neurosurg 48:34–41PubMedGoogle Scholar
  24. 24.
    Packer RJ, Savino PJ, Bilaniuk LT et al (1983) Chiasmatic gliomas of childhood: a reappraisal of natural history and effectiveness of cranial irradiation. Childs Brain 10:393–403PubMedGoogle Scholar
  25. 25.
    Packer RJ, Lange B, Ater J et al (1993) Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol 11:850–856PubMedGoogle Scholar
  26. 26.
    Pollack IF, Hurtt M, Pang D et al (1994) Dissemination of low-grade intracranial astrocytomas in children. Cancer 73:2869–2878PubMedGoogle Scholar
  27. 27.
    Prados M, Mamelak AN (1994) Metastasizing low-grade glioma in children. Redefining an old disease. Cancer 73:2671–2673PubMedGoogle Scholar
  28. 28.
    Shapiro K, Shulman K (1976) Spinal cord seeding from cerebellar astrocytomas. Childs Brain 2:177–186PubMedGoogle Scholar
  29. 29.
    Sioutos PJ, Hamilton AJ, Narotam PK et al (1996) Unusual early recurrence of a cerebellar pilocytic astrocytoma following complete surgical resection: case report and review of the literature. J Neurooncol 30:47–54CrossRefPubMedGoogle Scholar
  30. 30.
    Strupp R, Dietrich PY, Kraljevic SO et al (2002) Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 20:1375–1382Google Scholar
  31. 31.
    Tamura M, Zama A, Kurihara H et al (1998) Management of recurrent pilocytic astrocytoma with leptomeningeal dissemination in childhood. Childs Nerv Syst 14:617–622CrossRefPubMedGoogle Scholar
  32. 32.
    Trent S, Kong A, Short SC et al (2002) Temozolomide as second-line chemotherapy for relapsed gliomas. J Neurooncol 57:247–251CrossRefPubMedGoogle Scholar
  33. 33.
    Weiss L, Sagerman RH, King GA et al (1987) Controversy in the management of optic nerve glioma. Cancer 59:1000–1004PubMedGoogle Scholar
  34. 34.
    Wilson WB, Feinsod M, Hoyt WF et al (1976) Malignant evolution of childhood chiasmal pilocytic astrocytoma. Neurology 26:322–325PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Henry E. Aryan
    • 1
  • Hal S. Meltzer
    • 1
    • 2
  • Daniel C. Lu
    • 1
    • 3
  • Burak M. Ozgur
    • 1
  • Michael L. Levy
    • 1
    • 2
  • Derek A. Bruce
    • 2
  1. 1.Division of NeurosurgeryUniversity of California at San DiegoSan DiegoUSA
  2. 2.Division of NeurosurgeryChildren’s HospitalSan DiegoUSA
  3. 3.Department of NeurosciencesUniversity of California at San DiegoLa JollaUSA

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