NSRG-08. PEDIATRIC NEUROSURGEONS AS “TWO-WAY PLAYERS”

Abstract

To borrow a term from baseball, pediatric neurosurgeons should be “two-way players” like Shohei Ohtani in the treatment of low-grade glioma (LGG). In Japanese, a “two-way player” is called a “dual-sword player.” One sword is surgery, and the other is chemotherapy. Chemotherapy for pediatric brain tumor is managed by pediatric oncologists in many countries, but in Japan this task has traditionally fallen to neurosurgeons. Japanese neurosurgeons can choose between the two swords according to the situation. This system may be particularly effective in cases of LGG located in eloquent areas, as with optic pathway hypothalamic astrocytoma (OPHA) or cervicomedullary astrocytoma (CMA). Here, we clarified the effectiveness of “dual-sword” pediatric neurosurgeons. We retrospectively analyzed the cases of 25 pediatric LGG patients treated in our institute from 2004 to 2017. Ten cases were treated using surgery alone. Two cases were treated by surgery and radiotherapy. Five OHPAs, two CMAs and two spinal LGGs were treated by surgery and chemotherapy. The chemotherapeutic regimens used were a CBDCA/VCR regimen and a weekly VBL regimen. Although radiotherapy could only be used once after surgery, chemotherapy could be used repeatedly, and so could be alternated with surgical therapy depending on the situation. “Dual-sword” neurosurgeons deal with both surgery and chemotherapy, so the decision-making process is rapid and the transitions can be made smoothly. Because chemotherapy regimens for LGG are not complicated, unlike those for medulloblastoma, neurosurgeons familiar with chemotherapy can perform this task. Two-way pediatric neurosurgeons are important for the treatment of pediatric LGG.