38. Recurrent pediatric brain tumors: The role of surgery

The role of radical surgery and adjuvant therapies in the treatment of new diagnosed brain lesions has been focused in several clinical trials. On the contrary little has been done on recurrent pediatric brain tumors. Aggressive chemotherapy is the standard treatment for brain tumors relapses. The aim of our study is testing a protocol including a reoperation as soon as possible radical. Eligibility criteria were: patients with proved relapse, previously treated, located in a surgically amenable area; life expentancy higher than 2 mos; Karnofsky: 50 or higher; no evidence of extraneural dissemination. Patients with neurofibromatosis are excluded. This study showed that: surgical mortality and morbidity are not increased, never additional difficulties are encountered during reoperation in comparison with surgery of new diagnosed tumors. At present it is impossible to affirm if the aggressive surgical treatment of the relapses is the treatment of choice in all brain tumor recurrences. However our experience in MDB, compared with standard treatment of relapses, is encouraging. Results of surgery are not worse than conservative treatment; also morbidity is similar in two different treatment modalities. The treatment of relapsing pediatric brain tumors still represents a major challenge for neurosurgeon and oncologist. This protocol could be useful for prospective randomized studies trying to solve in a more objetive way the positive role of reoperation in the management of different CNS tumors, particularly in malignant oncotypes.