Treatment of Supratentorial Primitive Neuroectodermal Tumors (PNETs) in Children

  • Hwang, Jun-Mo (Department of Neurosurgery, Keimyung University School of Medicine) ;
  • Kim, Dong-Won (Department of Neurosurgery, Keimyung University School of Medicine) ;
  • Lee, Sung-Yeal (Department of Neurosurgery, Keimyung University School of Medicine) ;
  • Kim, Il-Man (Department of Neurosurgery, Keimyung University School of Medicine) ;
  • Lee, Chang-Young (Department of Neurosurgery, Keimyung University School of Medicine) ;
  • Yim, Man-Bin (Department of Neurosurgery, Keimyung University School of Medicine) ;
  • Son, Eun-Ik (Department of Neurosurgery, Keimyung University School of Medicine)
  • Published : 2005.03.31

Abstract

Objective: Strategies for managing supratentorial primitive neuroectodermal tumors(PNETs) in children include surgical resection, craniospinal irradiation and chemotherapy. This study is performed in order to compare the efficacy of various methods of treatment and to describe its optimal management. Methods: We have reviewed all medical records and pathology slides of six children(four males and two females) with supratentorial PNET from November, 1987 to May, 2003. The extent of resection was confirmed by computed tomography and magnetic resonance studies. Results: The patients were aged 1 to 13 years and treated postoperatively with/without adjuvant therapy. Tumor location included was four cortical, one gangliobasal, and one pineal region. The presenting symptoms and signs consisted of increased intracranial pressure and focal neurological deficits such as seizure and hemiparesis. The treatment consisted of surgical resection alone in one patient, postoperative radiotherapy in one patient, postoperative chemotherapy in one, and postoperative radiotherapy with chemotherapy in three. Five patients lived more than 12 months after diagnosis and one patient among them has been living more than 5 years after diagnosis. Conclusion: We can improve the survival and prognosis of supratentorial PNET patients by radical gross total resection of tumor followed by craniospinal irradiation and aggressive chemotherapy. First of all, gross total resection of tumor is the most important among many factors.

Keywords

References

  1. Albright AL, Wisoff JH, Zeltzer F, Boyett J, Rorke LB, Stanley P, et al : Prognostic factors in children with supratentorial(nonpineal) primitive neuroectodermal tumors. Pediatr Neurosurg 22 : 1-7, 1995 https://doi.org/10.1159/000121292
  2. Cohen BH, Zeltzer PM, Boyett JM, Geyer JR, Allen JC, Finlay JL, et al : Prognostic factors and treatment results for supratentorial primitive neuroectodermal tumors in children using radiation and chemotherapy : a childrens cancer group randomized trial. J Clin Oncol 13 : 1687- 1696, 1995
  3. Dirks PB, Harris L, Hoffman HJ, Humphreys RP, Drake JM, Rutka JT : Supratentorial primitive neuroectodermal tumors in children. J Neuro-oncol 29 : 75-84, 1996 https://doi.org/10.1007/BF00165520
  4. Hart MN, Earle KM : Primitive neuroectodermal tumors of the brain in children. Cancer 32 : 890-897, 1973 https://doi.org/10.1002/1097-0142(197310)32:4<890::AID-CNCR2820320421>3.0.CO;2-O
  5. Horten BC, Rubinstein LJ : Primary cerebral neuroblastoma, a clinicopathological study of 35 cases. Brain 99 : 735-756, 1976 https://doi.org/10.1093/brain/99.4.735
  6. Kosnik EJ, Boesel CP, Bay J, Sayers MP : Primitive neuroectodermal tumors of the central nervous system in children. J Neurosurg 48 : 741-746, 1978 https://doi.org/10.3171/jns.1978.48.5.0741
  7. Marec-Berard P, Jouvet A, Thiesse P, Kalifa C, Doz F, Frappaz D : Supratentorial embryonal tumors in children under 5 years of age : an SFOP study of treatment with postoperative chemotherapy alone. Med Pediatr Oncol 38 : 83-90, 2002 https://doi.org/10.1002/mpo.1277
  8. Mason WP, Grovas A, Halpern S, Dunkel IJ, Garvin J, Heller G, et al : Intensive chemotherapy and bone marrow rescue for young children with newly diagnosed malignant brain tumors. J Clin Oncol 16 : 210-221, 1998
  9. Mikaeloff Y, Raquin MA, Lellouch-Tubiana A, Terrier-Lacombe MJ, Michel Zerah, Bulteau C, et al : Primitive cerebral neuroectodermal tumors excluding medulloblastomas : a retrospective study of 30 cases. Pediatr Neurosurg 29 : 170-177, 1998 https://doi.org/10.1159/000028717
  10. Reddy AT, Janss AJ, Phillips PC, Weiss HL, Packer RJ : Outcome for children with supratentorial primitive neuroectodermal tumors treated with surgery, radiation, and chemotherapy. Cancer 88 : 2189- 2193, 2000 https://doi.org/10.1002/(SICI)1097-0142(20000501)88:9<2189::AID-CNCR27>3.0.CO;2-G
  11. Timmermann B, Kortmann RD, Kuhl J, Meisner C, Dieckmann K, Pietsch T, et al : Role of radiotherapy in the treatment of supratentorial primitive neuroectodermal tumors in childhood : results of the prospective German brain tumor trials HIT 88/89 and 91. J Clin Onco 20 : 842-849, 2002 https://doi.org/10.1200/JCO.20.3.842
  12. Tomita T, McLone DG, Yasue M : Cerebral primitive neuroectodermal tumors in childhood. J Neuro-oncol 6 : 233-243, 1988 https://doi.org/10.1007/BF00163707
  13. Tornesello A, Mastrangele S, Piciacchia D, Bembo V, Colosimo C, Rocco CD, et al : Progressive disease in children with medulloblastoma/PNET during preradiation chemotherapy. J Neuro-oncol 45 : 135-140, 1999 https://doi.org/10.1023/A:1006133404936
  14. Yang HJ, Nam DH, Wang KC, Kim YM, Chi JG, Cho BK : Supratentorial primitive neuroectodermal tumor in children : clinical features, treatment outcome and prognostic factors. Child's Nerv Syst 15 : 377-383, 1999 https://doi.org/10.1007/s003810050418