Tohoku J. Exp. Med., 2016 April, 238(4)

Neoadjuvant Chemotherapy for Facilitating Surgical Resection of Infantile Massive Intracranial Immature Teratoma

TAKAHIRO KITAHARA,¹ YOSHIHITO TSUJI,¹ TOMOYUKI SHIRASE,² HIROYUKI YUKAWA,¹ YASUHIRO TAKEICHI¹ and NAOHIRO YAMAZOE¹

¹Department of Neurosurgery, Otsu Red Cross Hospital, Otsu, Shiga, Japan
²Department of Pathology, Otsu Red Cross Hospital, Otsu, Shiga, Japan

Immature teratoma (IMT) is the most frequent histological subtype of infantile intracranial teratoma, the most common congenital brain tumor. IMT contains incompletely differentiated components resembling fetal tissues. Infantile intracranial IMT has a dismal prognosis, because it is often inoperable due to its massive size and high vascularity. Neoadjuvant chemotherapy has been shown to be effective in decreasing tumor volume and vascularity to facilitate surgical resection in other types of infantile brain tumors. However, only one recent case report described the effectiveness of neoadjuvant chemotherapy for infantile intracranial IMT in the literature, even though it is common entity with a poor prognosis in infants. Here, we describe the case of a 2-month-old male infant with a very large intracranial IMT. Maximal surgical resection was first attempted but was unsuccessful because of severe intraoperative hemorrhage. Neoadjuvant carboplatin and etoposide (CARE) chemotherapy was then administered with the aim of shrinking and devascularizing the tumor. After neoadjuvant chemotherapy, tumor size did not decrease, but intraoperative blood loss significantly decreased and near-total resection was achieved by the second and third surgery. The patient underwent adjuvant CARE chemotherapy and has been alive for 3 years after surgery without tumor regrowth. Even when neoadjuvant chemotherapy does not decrease tumor volume of infantile intracranial IMT, surgical resection should be tried because chemotherapy can facilitate surgical resection and improve clinical outcome by reducing tumor vascularity.

keywords —— immature teratoma; infantile brain tumor; intraoperative hemorrhage; neoadjuvant chemotherapy; tumor vascularity

© 2016 Tohoku University Medical Press

===============================

Tohoku J. Exp. Med., 2016, 238, 273-278

Correspondence: Takahiro Kitahara, Department of Neurosurgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga 520-8511, Japan.

e-mail: kitahara@kuhp.kyoto-u.ac.jp