Portal de Periódicos da CAPES

A multi-disciplinary consensus statement concerning surgical approaches to low-grade, high-grade astrocytomas and diffuse intrinsic pontine gliomas in childhood (CPN Paris 2011) using the Delphi method

2013; Oxford University Press; Volume: 15; Issue: 4 Linguagem: Inglês

10.1093/neuonc/nos330

1523-5866

David Walker, J. Liu, M. Kieran, Nada Jabado, Susan Picton, R. Packer, C. St. Rose, A. S. Van Meeteren, A. Carvalho, An Van Damme, Bart Depreitere, Bengt Gustavsson, B. J. Due Tonnessen, Anne-Isabelle Bertozzi-Salamon, Angela Brentrup, C. Raybaud, Chris Jones, Christelle Dufour, Christian Dorfer, Christian Sainte‐Rose, C. Malluci, Darren Hargrave, David J. F. Walker, Dannis G. van Vuurden, E. De Carli, Éric Bouffet, F Van Calenbergh, Didier Frappaz, Paolo Frassanito, James T. Goodrich, Heidi Baechli, J's Sports Bar and Grill, Jessica Ternier, Johan Cappelen, John Caird, J. R. Pereira, Laurent Riffaud, M. Baroncini, Marion Walker, M. Kieran, M. Memet Özek, Nada Jabado, Karsten Nysom, Pascale Varlet, John Goodden, Patrizia Bertolini, Giorgio Perilongo, Ph. Mercier, R. Grundy, R.-D. Kortmann, R. Packer, Stefan M. Pfister, Shlomi Constantini, Spiros Sgouros, Stefan Holm, Thomas Czech, T. Merchant, T. Stokland, Vita Ridola, W. Peter Vandertop,

Pituitary Gland Disorders and Treatments

Astrocytic tumors account for 42% of childhood brain tumors, arising in all anatomical regions and associated with neurofibromatosis type 1 (NF1) in 15%. Anatomical site determines the degree and risk of resectability; the more complete resection, the better the survival rates. New biological markers and modern radiotherapy techniques are altering the risk assessments of clinical decisions for tumor resection and biopsy. The increasingly distinct pediatric neuro-oncology multidisciplinary team (PNMDT) is developing a distinct evidence base. A multidisciplinary consensus conference on pediatric neurosurgery was held in February 2011, where 92 invited participants reviewed evidence for clinical management of hypothalamic chiasmatic glioma (HCLGG), diffuse intrinsic pontine glioma (DIPG), and high-grade glioma (HGG). Twenty-seven statements were drafted and subjected to online Delphi consensus voting by participants, seeking >70% agreement from >60% of respondents; where <70% consensus occurred, the statement was modified and resubmitted for voting. Twenty-seven statements meeting consensus criteria are reported. For HCLGG, statements describing overall therapeutic purpose and indications for biopsy, observation, or treatment aimed at limiting the risk of visual damage and the need for on-going clinical trials were made. Primary surgical resection was not recommended. For DIPG, biopsy was recommended to ascertain biological characteristics to enhance understanding and targeting of treatments, especially in clinical trials. For HGG, biopsy is essential, the World Health Organization classification was recommended; selection of surgical strategy to achieve gross total resection in a single or multistep process should be discussed with the PNMDT and integrated with trials based drug strategies for adjuvant therapies.