Advanced MRI for Pediatric Brain Tumors with Emphasis on Clinical Benefits

구현우,나영신 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.1

Conventional anatomic brain MRI is often limited in evaluating pediatric brain tumors, the most common solid tumors and a leading cause of death in children. Advanced brain MRI techniques have great potential to improve diagnostic performance in children with brain tumors and overcome diagnostic pitfalls resulting from diverse tumor pathologies as well as nonspecific or overlapped imaging findings. Advanced MRI techniques used for evaluating pediatric brain tumors include diffusion-weighted imaging, diffusion tensor imaging, functional MRI, perfusion imaging, spectroscopy, susceptibility-weighted imaging, and chemical exchange saturation transfer imaging. Because pediatric brain tumors differ from adult counterparts in various aspects, MRI protocols should be designed to achieve maximal clinical benefits in pediatric brain tumors. In this study, we review advanced MRI techniques and interpretation algorithms for pediatric brain tumors.

Tandem High-dose Chemotherapy without Craniospinal Irradiation in Treatment of Non-metastatic Malignant Brain Tumors in Very Young Children

Ma Youngeun,임도훈,Cho Heewon,이지원,성기웅,유건희,구홍회,신형진,서연림 대한의학회 2020 Journal of Korean medical science Vol.35 No.48

Background: Infants and very young children with malignant brain tumors have a poorer survival and a higher risk for neurologic deficits. The present study evaluated the feasibility and effectiveness of multimodal treatment including tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in minimizing use of radiotherapy (RT) in very young children with non-metastatic malignant brain tumors. Methods: Twenty consecutive patients younger than 3 years were enrolled between 2004 and 2017. Tandem HDCT/auto-SCT was performed after six cycles of induction chemotherapy. Local RT was administered only to patients with post-operative gross residual tumor at older than 3 years. Since September 2015, early post-operative local RT for patients with atypical teratoid/rhabdoid tumor or primitive neuroectodermal tumor was administered. Results: All 20 enrolled patients underwent the first HDCT/auto-SCT, and 18 proceeded to the second. Two patients died from toxicity during the second HDCT/auto-SCT, and four patients experienced relapse/progression (one localized and three metastatic), three of whom remained alive after salvage treatment including RT. A total of 17 patients remained alive at a median 7.8 (range, 2.5−15.7) years from diagnosis. Nine survivors received no RT, six survivors received local RT alone, and two survivors who experienced metastatic relapse after tandem HDCT/auto-SCT received both local and craniospinal RT. The 5-year overall, event- free, and craniospinal RT-free survival rates were 85.0% ± 8.0%, 70.0% ± 10.2%, and 75.0% ± 9.7%, respectively. Neuroendocrine and neurocognitive functions evaluated 5 years after tandem HDCT/auto-SCT were acceptable. Conclusion: Our results suggest that non-metastatic malignant brain tumors in very young children could be treated with multimodal therapy including tandem HDCT/auto-SCT while minimizing RT, particularly craniospinal RT.

소아청소년 교종

이미정 대한소아혈액종양학회 2016 Clinical Pediatric Hematology-Oncology Vol.23 No.1

Brain tumor is the second most common tumor in childhood. The overall survival (OS) has improved significantly during the past 30 years due to developments in surgical technique, radiotherapy, chemotherapy, and high-dose chemotherapy and autologous peripheral stem cell rescue. At present, the 5 year OS of pediatric brain tumor is about 75% which, however, is still lower than that of other malignancies in childhood. Various clinical studies using radiotherapy combined with chemotherapy, multidrug chemotherapy, and monoclonal antibody have been conducted in order to cure patients with brain tumor. The Korean Society of Pediatric Neuro-Oncology is trying to develop standard therapy for the various types of pediatric brain tumor. Of special note, the standard treatment for pediatric glioma has not yet been established. Glioma is the most common histologic type of brain tumor in children. They are classified into 3 groups based on the WHO grade and location of tumor; low-grade glioma (LGG), high-grade glioma (HGG), and brainstem glioma (BSG). The prognosis of LGG is usually good if a complete surgical resection is feasible. Incomplete resected or progressive LGG are troublesome disease for pediatric oncologists. The survival rate of HGG and BSG is very low in spite of combined treatments with surgery, radiation, and chemotherapy. The aim of this review is to provide an overview of treatments for pediatric gliomas.

신경섬유종증 II형 소아에서 발생한 거대 삼차신경초종

이문영,김태영,문성근,김종문,Lee, Mun Young,Kim, Tae Young,Moon, Seong Keun,Kim, Jong Moon 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

We report a case of huge trigeminal schwannoma in a 10-year-old boy with neurofibromatosis type II, extending into the three spaces of the left middle, posterior, and infratemporal fossa. Initially we thought the child had a solitary trigeminal schwannoma, and most of the mass was resected successfully through one-stage operation, cranio-orbito-zygomatic intradural approach. However during the follow-up of the patient we found radiographically other multiple intracranial tumors of bilateral acoustic schwannomas, right trigeminal schwannoma, and foramen magnum tumor. Eventually the patient was diagnosed as neurofibromatosis type II presenting multiple intracranial tumors. We think childhood trigeminal schwannoma, even though in the case of solitary tumor, should be considered as possible initial manifestation of neurofibromatosis type II and that careful follow-up for the possibility of occurrence of other brain tumors such as schwannomas or meningiomas is necessary.

소아 뇌종양의 임상 및 방사선 소견에 대한 고찰

조성범,김동원,강진무,우영훈,김명성,김흥식 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.4

The analysis of the clinical and radiological findings were performed on 41 cases of brain tumor in children under the age of 15 years who were admitted to Pediatric department of Dongsan Medical Center,Keimyung University, School of Medicine between May 1987 and September 1992. The clinical and rediological findings were analysed retrospectively. The results were as follows : The male to female ratio was 2.7 : 1 and the peak incidence of age was between 10 and15 years(39.0%). The supratentorial tumors were found more frequently(60.9%) than the infratentorial tumors(39.1%). Histopathologically, the astrocytoma was most common(24.4%), followed by medulloblastoma, ependymoma, craniopharyngioma. The main symptoms of the supratentorial tumors were headache(64.0%), vomiting(56.0%), nausea(44.0%),visual disturbance(32.o%), convulsion(24.0%), and endocrine dysfunction(8.0%), in order of frequency. Those of the infratentorial tumors were vomiting(87.5%), nausea(75.0%), headache(62.5%),papilledema(37.5%), ataxia(25.0%), convulsion(18.8%). The brain CT findings were different according to the histopathological findings. Most of the astrocytoma showed cystic nature, low density, and inhomogenous enhancement. Medulloblastoma was mostly located at infratentorium, and showed well enhancement and hydrocephalus in all cases. Craniopharyngioma showed suprasella hypodensed mass lesions with calcificaion in all cases. Ependymoma showed well enhancement and marked hydrocephalus in cases. 40 cases except one case of metastatic ganglioneuroblastoma had undergone complete or partial resection. Twelve patients were irradiated and 3 patients received chemotherapy after surgery. Eight patients received combind therapy with surgery, radiotherapy and chemotherapy. Out of 40 cases who received surgery, the follow up study was possible on 24 cases of which 11 cases have been alive, including 5 cases who has been survive more than 2 years.

Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for High-Grade Gliomas in Children and Adolescents

이지원,임도훈,성기웅,이형진,이은상,유건희,Hong Hoe Koo,서연림,신형진 대한의학회 2017 Journal of Korean medical science Vol.32 No.2

With the aim to investigate the outcome of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) for high-grade gliomas (HGGs), we retrospectively reviewed the medical records of 30 patients with HGGs (16 glioblastomas, 7 anaplastic astrocytomas, and 7 other HGGs) between 2006 and 2015. Gross or near total resection was possible in 11 patients. Front-line treatment after surgery was radiotherapy (RT) in 14 patients and chemotherapy in the remaining 16 patients including 3 patients less than 3 years of age. Eight of 12 patients who remained progression free and 5 of the remaining 18 patients who experienced progression during induction treatment underwent the first HDCT/auto-SCT with carboplatin + thiotepa + etoposide (CTE) regimen and 11 of them proceeded to the second HDCT/auto-SCT with cyclophosphamide + melphalan (CyM) regimen. One patient died from hepatic veno-occlusive disease (VOD) during the second HDCT/auto-SCT; otherwise, toxicities were manageable. Four patients in complete response (CR) and 3 of 7 patients in partial response (PR) or second PR at the first HDCT/auto-SCT remained event free: however, 2 patients with progressive tumor experienced progression again. The probabilities of 3-year overall survival (OS) after the first HDCT/auto-SCT in 11 patients in CR, PR, or second PR was 58.2% ± 16.9%. Tumor status at the first HDCT/auto-SCT was the only significant factor for outcome after HDCT/auto-SCT. There was no difference in survival between glioblastoma and other HGGs. This study suggests that the outcome of HGGs in children and adolescents after HDCT/auto-SCT is encouraging if the patient could achieve CR or PR before HDCT/auto-SCT.