PEDIATRIC LOW-GRADE GLIOMAS: A FINE BALANCE BETWEEN TREATMENT OPTIONS, TIMING OF THERAPY, SYMPTOM MANAGEMENT AND QUALITY OF LIFE: EXPERIENCE FROM A TERTIARY CARE CENTRE IN LMIC

Abstract

Pediatric low-grade gliomas (LGGs) are the most frequently observed brain tumors in the pediatric age groups. Diagnosing LGGs generally needs a combination of imaging and histopathological studies following the biopsy. As LGGs are generally benign, their location may contribute to major complications, especially when located near critical brain structures. Treatment in pediatric LGGs usually invovles surgery, chemotherapy, and occasionally radiation therapy, and the choice is based on the location of the tumor, along with the symptoms and overall clincial profiling of the child. This case reports presents a 5-year-old boy who was havinga BRAF-positive pilocytic astrocytoma, and developed progressive symptoms. Initial surgery could only have achieved partial resection due to the tumor’s deep and awkward location in the suprasellar and basal ganglia areas. The children was advised to undergo a 70-week course of vinblastine chemotherapy, which resulted in temporary stabilization of the initial symptoms. However, the disease progressed in the following period, requiring a 2nd line treatment with vincristine and carboplatin that resulted in only partial response. Subsequent interventions invovled palliative radiotherapy and the placement of an Ommaya reservoir to drain the cystic fluid, which yielded neurological improvements. This case report highlights the challenges of treating refractory pediatric LGGs, especially at a tertiary care center of a resource-limited setting.