Neoadjuvant chemotherapy for pineal region tumors

Area of Science:

• Pediatric neurosurgery
• Pediatric oncology
• Neuro-oncology

Background:

• Pineal region tumors often present as large masses, causing obstructive hydrocephalus.
• Surgical resection is challenging due to tumor vascularity and proximity to critical neurovascular structures.
• Neoadjuvant chemotherapy is explored to reduce tumor size and vascularity before surgery, especially in pediatric cases.

Purpose of the Study:

• To evaluate the efficacy and safety of neoadjuvant chemotherapy in reducing the volume of pediatric pineal region tumors.
• To assess the impact of neoadjuvant chemotherapy on surgical resection and patient outcomes.

Main Methods:

• Retrospective review of pediatric patients with pineal region/posterior third ventricular tumors treated with neoadjuvant chemotherapy (carboplatin, etoposide, cyclophosphamide).
• Tumor volume reduction calculated using MRI analytics before and after chemotherapy.
• Secondary outcomes included blood loss, extent of resection, complications, readmission rates, and survival.

Main Results:

• Thirty-one pediatric patients (mean age 7.42 years) with predominantly embryonal tumors (71% pineoblastoma) were included.
• Average tumor volume reduction was 51% post-chemotherapy, with no chemotherapy-related complications.
• Gross total or near-total resections were achieved with an average blood loss of 11.7% of total blood volume.

Conclusions:

• Neoadjuvant chemotherapy is a safe and effective strategy for decreasing pineal region tumor volume in pediatric patients.
• Tumor volume reduction may facilitate surgical resection, though further multicenter studies are warranted.