The Role of Adjunctive Therapy of Optic Pathway Glioma in Children.

Jang, Jong Ho; Ra, Young Shin; Kim, Jeong Hun; Lee, Jeong Gyo; Khang, Shin Kwang; Ghim, Thad T

Original Article

Journal of Korean Neurosurgical Society 2004;35(2): 136-141.

Jong Ho Jang, Young Shin Ra, Jeong Hun Kim, Jeong Gyo Lee, Shin Kwang Khang, Thad T Ghim

¹Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. ysra@amc.seoul.kr
²Department of Pathology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
³Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

ABSTRACT

OBJECTIVE
This study is performed in order to compare the outcomes of surgical management and to define the role of adjunctive therapy in the management of optic pathway glioma in children. METHODS: Sixteen children with optic pathway glioma had been managed in various treatment methods during the last 8 years. The patients aged from 5 months to 14 years. The patients presented with progressive visual loss, increased ICP symptoms, endocrine dysfunction, seizure, and motor weakness. Optic pathway glioma associated with neurofibromatosis was excluded. Tumor involved chiasmatico-hypothalamus(12 patients), optic chiasm(3), and optic nerve(1). The extent of surgical resection were radical(3 patients), subtotal(12), and partial(1). RESULTS: Three patients treated with radical resection showed no evidence of tumor recurrence. Among 12 patients treated with subtotal resection and without adjunctive therapy, 6 patients(50%) developed recurrence in the postoperative period of average 20.5 months. Those patients with recurrence were managed by reoperation(3 patients), irradiation therapy(2), and chemotherapy(1). However three patients with residual tumors after subtotal(2), or partial(1) resection were treated with adjunctive chemotherapy in the postoperative period showed no evidence of recurrence. CONCLUSION: Although radical resection of optic pathway glioma might offer long-term control of tumor, adjunctive chemotherapy could be effective to prevent tumor recurrence in children with subtotally or partially resected optic pathway glioma. More experience is necessary to determine the optimal method of treatment of optic pathway gliomas in children.

Key Words: Optic pathway glioma; Surgery; Radiotherapy; Chemotherapy; Outcome; Children