Low-dose cisplatin combined with etoposide in the treatment of low-grade glioma in the sellar region of children with diencephalic syndrome: A report of four cases

Objective To investigate the therapeutic effect of low-dose cisplatin combined with etoposide on low-grade glioma in the sellar region of children with diencephalic syndrome. Methods The clinical characteristics, treatment and outcomes of 4 children with diencephalic syndrome secondary to low-grade glioma in the sellar region were retrospectively analyzed who were admitted to Department of Neurosurgery, Children's Hospital of Fudan University from January 2015 to December 2017. Of 4 cases, 2 were females and 2 were males. The range of age was 6 months to 34 months, with the median age of 16 months. One case with severe hydrocephalus was treated with ventriculoperitoneal shunt surgery. Surgical biopsy or resection was not performed in this series. Low doses of cisplatin (1 mg·kg-1·d-1 d0-d2) and etoposide (5 mg·kg-1·d-1, d0-d2) were used for 10 cycles of chemotherapy to observe the clinical effect. Results All cases successfully completed chemotherapy and no obvious side effects of chemotherapy were reported. Follow-up post chemotherapy lasted for 6 to 20 months (with the median duration of 12 months). The clinical symptoms were better than before and the weight was about 29.3%-50.0% higher than before. The starting time to gain weight was 3 to 12 months after the initiation of chemotherapy (with the median duration of 7 months). There was no progress in the review of cranial MRI saddle area in 2 cases, tumor reduction in 1, substance decrease in 1, disappearance of cisterna ambiens lesion in 1 and disappearance of the fourth ventricular lesion in 1. There was no significant change in hormone level compared with conditions prior to chemotherapy. One case gained weight at 1 year post chemotherapy and presented good clinical performance. Partial resection of tumor was performed. Its final pathological result was pilocytic astrocytoma (WHO Ⅰ) and further radiotherapy was administered. Conclusions The chemotherapy regimen of low-dose cisplatin combined with etoposide seems to have a good effect which was to improve the clinical symptoms and postpone the tumor progression of children with diencephalic syndrome secondary to low-grade gliomas in the sellar region. Key words: Glioma; Child; Cisplatin; Etoposide; Diencephalic syndrome; Sellar region; Low-grade