Defining the best available treatment for neurocytomas in children

Abstract

Background: In children, neurocytomas are extremely rare tumors in the central nervous system. Since this entity was introduced in 1982, approximately 60 cases have been reported among patients age </= =18 years of age. The current analysis was performed to define the best available neurocytoma therapy in children.

Methods: All reported neurocytoma cases were reviewed for age, extent of resection, radiotherapy, radiotherapy dose, local control, and survival. Data were obtained from the literature and the authors. Statistical analysis was performed with the Kaplan-Meier method and log-rank test.

Results: Fifty-nine children were categorized by therapy: complete tumor resection (CTR; n = 20), complete tumor resection plus radiotherapy (CTR-RT; n = 11), incomplete tumor resection (ITR; n = 14), and incomplete tumor resection plus radiotherapy (ITR-RT; n = 14). Local control rates were better after CTR, CTR-RT, and ITR-RT than after ITR, at 5 years (86%, 100%, and 100% vs. 60%; P < 0.001) and at 10 years (86%, 100%, and 100% vs. 45%; P < 0.001). The 5-year and 10-year survival rates were 100% after CTR, 100% after CTR-RT, 100% after ITR-RT, and 93% after ITR (P = 0.4). In the ITR-RT group, no difference was observed between doses </= 50 gray (Gy) and >/= 54 Gy when compared for local control (P = 1.0) and survival rates (P = 1.0). Radiotherapy-related psychomotor retardation or secondary brain tumors were not reported.

Conclusions: The prognosis of children with neurocytomas is extremely good. CTR was associated with better local control and survival rates than ITR. After ITR, radiotherapy improves local control, but not survival. If postoperative radiotherapy is considered, a dose of 50 Gy was appropriate for long-term local control in children, whereas higher doses were required in adults.