Role of Adjuvant Therapy after Neurosurgery in Pediatric Low Grade Gliomas

Introduction: LGG represent the largest group of cerebral tumors in the pediatric population. Although a complete tumor resection is the main purpose in these lesions management, in many cases is not so easy, due to the difficulty in determination of oncologyc limits of surgical procedures. This raises several important questions on the long-term behavior of the residual tumor and the role of adjuvant therapy in the management of theese lesions. Material and Methods: The authors reviewed their experience in more than 400 cases of LGG (including spinal) and literature-review. We consider: pilocytic astrocytoma (62.99%), fibrillary astrocytoma (15.44%), ganglioglioma (11.03%), gangliocytoma (1.71%), oligodendroglioma (1.96%), oligoastrocytoma (4.9%), pleomorphic xanthoastrocytoma (0.49%), dysembrioplastic neuroepithelial tumor (1.23%), ependimoma (0.24%); et.al. Results: In our serie, surgical resection was 49.26% total and 50.73% subtotal. Recurrencies at 5 years were 7.35% and at 10 years 7.59%.. The use of radiotherapy was not associated with such a significant improvement in overall survival. In our opinion, according to SIOP LGG study Master Protokoll 2004 and 2010, chemotherapy (Carboplatin, et.al.) has a consolidating role in the treatment of children with LGG . The progression free survival datas are increasing but still not so satisfactory. Conclusions: We advocate as much as possible for surgical resection. After aggressive surgery, and also in recurrencies, radiotherapy and chemotherapy should be re-considered. Multimodal treatment and a good colaboration between neurosurgeons and oncologysts represent the main goal to achieve better results in LGG pathology.