The role of radiation in pediatric oligodendrogliomas

Abstract Oligodendrogliomas are glial tumors that occur rarely in pediatric patients compared to adults. They tend to be low grade, although anaplastic oligodendrogliomas do occur and portend a decreased overall survival. Surgical management is important for both diagnostic and treatment purposes, and patients achieving a gross total resection generally fare well without adjuvant chemotherapy or radiation. Nonetheless, there is a role for medical or radiation-based management of these tumors in the setting of residual or recurrent disease. The role of chemotherapy is changing, especially in the adult population, where genomic data have revealed distinct mutations present in the majority of oligodendrogliomas that correlate with prognosis. This model has yet to be replicated in pediatric oligodendrogliomas, and outside of anaplastic oligodendrogliomas, outcomes continue to be superior for pediatric patients. Oligodendrogliomas are sensitive to radiation, which can be curative, but in pediatric patients consideration must be given to the excess morbidity of cranial radiation in the setting of a low-mortality disease. Overall, oligodendrogliomas are rare in pediatric patients and appear to have distinct biologic drivers compared to adult patients. These facts combined with the unique considerations of the developing brain make radiation a carefully chosen treatment modality, reserved for the most aggressive cases.