Adjuvant Therapies for Central Neurocytomas in Children
None needed with gross total resection: There is consensus that no adjuvant therapy is needed for classical central neurocytomas that have been completely removed.
Controversy with subtotal resections: There is no unanimity of opinion about adjuvant therapy in the cases of subtotally removed tumors and tumors that are atypical or extraventricular. The three choices that have been proposed are 1) postoperative radiotherapy, 2) radiotherapy at the first sign of progression, and 3) reoperation only.
Atypical neurocytomas: The use of procarbazine, vincristine, and CCNU has been recommended for atypical neurocytomas (35). The use of high-dose chemotherapy with stem cell rescue has been described in a 9-month-old child with atypical neurocytoma not amenable to radiotherapy (36).
Conventional radiotherapy: Radiotherapy has been recommended for 1) incompletely resected central neurocytomas, 2) atypical neurocytomas, and 3) those tumors with a high mitotic index even though the lesion is classical neurocytoma (37). Doses of up to 50 Gy have been shown to be adequate in controlling local disease compared to higher doses used in this condition (36).
Gamma knife: Recently, gamma knife radiosurgery has been shown to be effective (38) in the treatment of these tumors, although the numbers are small and follow-up times are short thus far.
Not reported: The use of immunotherapy or other therapies has not been described.