Management of Supratentorial Pleomorphic Xanthoastrocytomas in Children

Initial Management at Presentation

• Control of seizures
• Surgical resection: Total resection is the treatment of choice (16).

Adjunctive Therapies

• Chemotherapy limited: Chemotherapy is usually considered ineffective for localized tumors (13, 25) but has been tried as a presurgical treatment to decrease blood loss (24). It has also been used in cases with leptomeningeal dissemination (28).
• Radiation for anaplasia: Radiation therapy has a role only in PXAs with anaplastic features or in recurrent PXAs.

Follow-up

• Scheduled follow-up: Typically, follow-up is planned for 4–6 weeks after surgery.
• Postoperative imaging important: The first postoperative imaging should be done within 72 hours to make sure there is no residual tumor or to assess its size if tumor remains. Follow-up imaging will then depend on the pathology of the tumor (anaplastic or not). Typically, classical PXAs would be followed every year for the first 10 years, then every 2–3 years after that.