Clinical outcome of pediatric choroid plexus tumors: retrospective analysis from a single institute
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Abstracts
Background
Choroid plexus tumor is a rare brain tumor with variable clinical features according to the histological grade. We reviewed the treatment outcome of 23 children, focusing on the biological behavior of the atypical choroid plexus papilloma (ACPP) and the current therapeutic strategy in choroid plexus carcinoma (CPC).
Methods
The demographics, clinical features, surgical treatments, adjuvant therapies, and survival were reviewed.
Results
The median age at diagnosis was 18 months—55 months for choroid plexus papilloma (CPP), 8 months for ACPP, and 15 months for CPC. Gross total resections were achieved in seven of eight patients with CPP, seven of seven with ACPP, and three of eight with CPC. Seven patients with CPC received chemotherapy. Four patients received high-dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplantation (aPBSCT), and three among them have survived. Four patients with CPC received radiotherapy. One CPP patient and one CPC patient underwent radiosurgery. All CPP and ACPP patients have survived. The overall survival rate of the CPC patients was 62.5 % in the first year and 42.9 % in the second year. The progression-free survival rate of the CPC patients was 50 % in the first year and 0 % in the second year. Seven patients underwent permanent cerebrospinal fluid diversion surgery because of hydrocephalus or subdural effusion.
Conclusion
CPP and ACPP were surgically curable. Multi-modal treatments are necessary in the management of CPC with poor prognosis. HDCT and aPBSCT may be important to treat infants for whom radiotherapy is limited. Hydrocephalus and subdural effusion should be resolved with appropriate management.
Keywords
Choroid plexus tumor Choroid plexus papilloma Atypical choroid plexus papilloma Choroid plexus carcinoma HydrocephalusNotes
Acknowledgment
This study was supported by a grant from the Korea Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120446).
References
- 1.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2007) WHO classification of tumours of the central nervous system, 3rd edn. IARC, LyonGoogle Scholar
- 2.Naeini RM, Yoo JH, Hunter JV (2009) Spectrum of choroid plexus lesions in children. AJR Am J Roentgenol 192(1):32–40. doi: 10.2214/AJR.08.1128 PubMedCrossRefGoogle Scholar
- 3.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109. doi: 10.1007/s00401-007-0243-4 PubMedCentralPubMedCrossRefGoogle Scholar
- 4.McEvoy AW, Harding BN, Phipps KP, Ellison DW, Elsmore AJ, Thompson D, Harkness W, Hayward RD (2000) Management of choroid plexus tumours in children: 20 years experience at a single neurosurgical centre. Pediatr Neurosurg 32(4):192–199PubMedCrossRefGoogle Scholar
- 5.Due-Tonnessen B, Helseth E, Skullerud K, Lundar T (2001) Choroid plexus tumors in children and young adults: report of 16 consecutive cases. Child Nerv Syst 17(4–5):252–256CrossRefGoogle Scholar
- 6.Krishnan S, Brown PD, Scheithauer BW, Ebersold MJ, Hammack JE, Buckner JC (2004) Choroid plexus papillomas: a single institutional experience. J Neurooncol 68(1):49–55PubMedCrossRefGoogle Scholar
- 7.Wolff JE, Sajedi M, Brant R, Coppes MJ, Egeler RM (2002) Choroid plexus tumours. Br J Cancer 87(10):1086–1091. doi: 10.1038/sj.bjc.6600609 PubMedCentralPubMedCrossRefGoogle Scholar
- 8.Jeibmann A, Hasselblatt M, Gerss J, Wrede B, Egensperger R, Beschorner R, Hans VH, Rickert CH, Wolff JE, Paulus W (2006) Prognostic implications of atypical histologic features in choroid plexus papilloma. J Neuropathol Exp Neurol 65(11):1069–1073. doi: 10.1097/01.jnen.0000240464.26005.90 PubMedCrossRefGoogle Scholar
- 9.Berrak SG, Liu DD, Wrede B, Wolff JE (2011) Which therapy works better in choroid plexus carcinomas? J Neurooncol 103(1):155–162. doi: 10.1007/s11060-010-0372-9 PubMedCrossRefGoogle Scholar
- 10.Wrede B, Liu P, Wolff JE (2007) Chemotherapy improves the survival of patients with choroid plexus carcinoma: a meta-analysis of individual cases with choroid plexus tumors. J Neurooncol 85(3):345–351. doi: 10.1007/s11060-007-9428-x PubMedCrossRefGoogle Scholar
- 11.Fitzpatrick LK, Aronson LJ, Cohen KJ (2002) Is there a requirement for adjuvant therapy for choroid plexus carcinoma that has been completely resected? J Neurooncol 57(2):123–126PubMedCrossRefGoogle Scholar
- 12.Berger C, Thiesse P, Lellouch-Tubiana A, Kalifa C, Pierre-Kahn A, Bouffet E (1998) Choroid plexus carcinomas in childhood: clinical features and prognostic factors. Neurosurgery 42(3):470–475PubMedCrossRefGoogle Scholar
- 13.Lafay-Cousin L, Keene D, Carret AS, Fryer C, Brossard J, Crooks B, Eisenstat D, Johnston D, Larouche V, Silva M, Wilson B, Zelcer S, Bartels U, Bouffet E (2011) Choroid plexus tumors in children less than 36 months: the Canadian Pediatric Brain Tumor Consortium (CPBTC) experience. Child Nerv Syst 27(2):259–264. doi: 10.1007/s00381-010-1269-9 CrossRefGoogle Scholar
- 14.Bettegowda C, Adogwa O, Mehta V, Chaichana KL, Weingart J, Carson BS, Jallo GI, Ahn ES (2012) Treatment of choroid plexus tumors: a 20-year single institutional experience. J Neurosurg Pediatr 10(5):398–405. doi: 10.3171/2012.8.PEDS12132 PubMedCrossRefGoogle Scholar
- 15.Wrede B, Hasselblatt M, Peters O, Thall PF, Kutluk T, Moghrabi A, Mahajan A, Rutkowski S, Diez B, Wang X, Pietsch T, Kortmann RD, Paulus W, Jeibmann A, Wolff JE (2009) Atypical choroid plexus papilloma: clinical experience in the CPT-SIOP-2000 study. J Neurooncol 95(3):383–392. doi: 10.1007/s11060-009-9936-y PubMedCrossRefGoogle Scholar
- 16.Yu H, Yao TL, Spooner J, Stumph JR, Hester R, Konrad PE (2006) Delayed occurrence of multiple spinal drop metastases from a posterior fossa choroid plexus papilloma. Case report. J Neurosurg Spine 4(6):494–496. doi: 10.3171/spi.2006.4.6.494 PubMedCrossRefGoogle Scholar
- 17.Shintaku M, Nitta T, Matsubayashi K, Okamoto S (2008) Ossifying choroid plexus papilloma recurring with features of atypical papilloma. Neuropathology 28(2):160–164. doi: 10.1111/j.1440-1789.2007.00836.x PubMedCrossRefGoogle Scholar
- 18.Leblanc R, Bekhor S, Melanson D, Carpenter S (1998) Diffuse craniospinal seeding from a benign fourth ventricle choroid plexus papilloma. Case report. J Neurosurg 88(4):757–760. doi: 10.3171/jns.1998.88.4.0757 PubMedCrossRefGoogle Scholar
- 19.Uff CE, Galloway M, Bradford R (2007) Metastatic atypical choroid plexus papilloma: a case report. J Neurooncol 82(1):69–74. doi: 10.1007/s11060-006-9238-6 PubMedCrossRefGoogle Scholar
- 20.Jeibmann A, Wrede B, Peters O, Wolff JE, Paulus W, Hasselblatt M (2007) Malignant progression in choroid plexus papillomas. J Neurosurg 107(3 Suppl):199–202. doi: 10.3171/PED-07/09/199 PubMedGoogle Scholar
- 21.Tanaka K, Sasayama T, Nishihara M, Sakagami Y, Kondoh T, Ohbayashi C, Kohmura E (2009) Rapid regrowth of an atypical choroid plexus papilloma located in the cerebellopontine angle. J Clin Neurosci 16(1):121–124. doi: 10.1016/j.jocn.2008.02.021 PubMedCrossRefGoogle Scholar
- 22.Tena-Suck ML, Salinas-Lara C, Rembao-Bojorquez D, Castillejos M (2010) Clinicopathologic and immunohistochemical study of choroid plexus tumors: single-institution experience in Mexican population. J Neurooncol 98(3):357–365. doi: 10.1007/s11060-009-0080-5 PubMedCrossRefGoogle Scholar
- 23.Chow E, Jenkins JJ, Burger PC, Reardon DA, Langston JW, Sanford RA, Heideman RL, Kun LE, Merchant TE (1999) Malignant evolution of choroid plexus papilloma. Pediatr Neurosurg 31(3):127–130PubMedCrossRefGoogle Scholar
- 24.Haliasos N, Brew S, Robertson F, Hayward R, Thompson D, Chakraborty A (2013) Preoperative embolisation of choroid plexus tumours in children: part I—does the reduction of perioperative blood loss affect the safety of subsequent surgery? Child Nerv Syst 29(1):65–70. doi: 10.1007/s00381-012-1912-8 CrossRefGoogle Scholar
- 25.Souweidane MM, Johnson JH Jr, Lis E (1999) Volumetric reduction of a choroid plexus carcinoma using preoperative chemotherapy. J Neurooncol 43(2):167–171PubMedCrossRefGoogle Scholar
- 26.Lafay-Cousin L, Mabbott DJ, Halliday W, Taylor MD, Tabori U, Kamaly-Asl ID, Kulkarni AV, Bartels U, Greenberg M, Bouffet E (2010) Use of ifosfamide, carboplatin, and etoposide chemotherapy in choroid plexus carcinoma. J Neurosurg Pediatr 5(6):615–621. doi: 10.3171/2010.3.PEDS09354 PubMedCrossRefGoogle Scholar
- 27.Greenberg ML (1999) Chemotherapy of choroid plexus carcinoma. Child Nerv Syst 15(10):571–577CrossRefGoogle Scholar
- 28.Cheuk DK, Lee TL, Chiang AK, Ha SY, Chan GC (2008) Autologous hematopoietic stem cell transplantation for high-risk brain tumors in children. J Neurooncol 86(3):337–347. doi: 10.1007/s11060-007-9478-0 PubMedCrossRefGoogle Scholar
- 29.Rosenfeld A, Kletzel M, Duerst R, Jacobsohn D, Haut P, Weinstein J, Rademaker A, Schaefer C, Evans L, Fouts M, Goldman S (2010) A phase II prospective study of sequential myeloablative chemotherapy with hematopoietic stem cell rescue for the treatment of selected high risk and recurrent central nervous system tumors. J Neurooncol 97(2):247–255. doi: 10.1007/s11060-009-0009-z PubMedCrossRefGoogle Scholar
- 30.Panosyan EH, Ikeda AK, Chang VY, Laks DR, Reeb CL, Bowles LV, Lasky JL III, Moore TB (2011) High-dose chemotherapy with autologous hematopoietic stem-cell rescue for pediatric brain tumor patients: a single institution experience from UCLA. J Transplant 2011:740673. doi: 10.1155/2011/740673 PubMedCentralPubMedCrossRefGoogle Scholar
- 31.Bostrom A, Bostrom JP, von Lehe M, Kandenwein JA, Schramm J, Simon M (2011) Surgical treatment of choroid plexus tumors. Acta Neurochir (Wien) 153(2):371–376. doi: 10.1007/s00701-010-0828-x CrossRefGoogle Scholar
- 32.Samuel TA, Parikh J, Sharma S, Giller CA, Sterling K, Kapoor S, Pirkle C, Jillella A (2013) Recurrent adult choroid plexus carcinoma treated with high-dose chemotherapy and syngeneic stem cell (bone marrow) transplant. J Neurol Surg A Cent Eur Neurosurg. doi: 10.1055/s-0032-1333419
- 33.Wolff JE, Sajedi M, Coppes MJ, Anderson RA, Egeler RM (1999) Radiation therapy and survival in choroid plexus carcinoma. Lancet 353(9170):2126PubMedCrossRefGoogle Scholar
- 34.Mazloom A, Wolff JE, Paulino AC (2010) The impact of radiotherapy fields in the treatment of patients with choroid plexus carcinoma. Int J Radiat Oncol Biol Phys 78(1):79–84. doi: 10.1016/j.ijrobp.2009.07.1701 PubMedCrossRefGoogle Scholar
- 35.Kim IY, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD (2008) Gamma knife radiosurgery for treatment resistant choroid plexus papillomas. J Neurooncol 90(1):105–110. doi: 10.1007/s11060-008-9639-9 PubMedCrossRefGoogle Scholar
- 36.Duke BJ, Kindt GW, Breeze RE (1997) Pineal region choroid plexus papilloma treated with stereotactic radiosurgery: a case study. Comput Aided Surg 2(2):135–138. doi: 10.1002/(SICI)1097-0150(1997)2:2<135::AID-IGS6>3.0.CO;2–0 PubMedCrossRefGoogle Scholar
- 37.Di Rocco C, Iannelli A (1997) Poor outcome of bilateral congenital choroid plexus papillomas with extreme hydrocephalus. Eur Neurol 37(1):33–37PubMedCrossRefGoogle Scholar
- 38.Kumar R, Singh S (2005) Childhood choroid plexus papillomas: operative complications. Child Nerv Syst 21(2):138–143. doi: 10.1007/s00381-004-0993-4 CrossRefGoogle Scholar
- 39.Park HS, Kim SH, Lee KC (1996) Subdural fluid collection following ruptured aneurysm surgery as a manifestation of disturbed cerebrospinal fluid circulation. J Korean Neurosurg Soc 25(4):769–777Google Scholar