Pilomyxoid astrocytomas: Chemotherapy

Pilomyxoid astrocytoma (PMA) is a variant of pilocytic astrocytoma (PA). However, PMA shows a higher rate of recurrence and dissemination in cerebrospinal fluid (CSF) than does pilocytic astrocytoma (PA). PMA occurs predominantly in the hypothalamic/chiasmic region, and thus it is usually treated with chemotherapy following surgical biopsy. We discuss the treatment of PMA. Materials and Methods: Between 1992 and 2009, the authors treated 5 patients, 2 males and 3 females, ranging in age from 3 months to 11 years. Results: Three patients showed CSF dissemination on the initial radiographic examination. All patients received chemotherapy; the most commonly used drug combination was that of cisplatin (CDDP)/carboplatin (CBDCA) and etoposide. If these drugs were unsuccessful, they were changed, or other drugs were added to the combination. After chemotherapy, four patients showed remarkable tumor regression. Nevertheless, one patient died due to tumor progression 22 months after initial diagnosis. Conclusion: Although our series comprised a small number of patients, treatment of PMA with chemotherapy appeared to be of value. Even if initial chemotherapy is ineffective, we recommend continued CDDP/CBDCA-based chemotherapy with new drug combinations.