We discussed Zlata yesterday:
1. The pathology fits to the diagnosis of pilocatic astrocytoma I (final analyses pending) as well as the MRIs.
2. The response of the tumor to chemotherapy was there during 2007, but not a very clear response.
3. From January 08 - June 08 we could see predominantly the development of a tumor cyst, but not a significant progression of the solid tumor in MRIs.
4. The surgery in June 08 lead to a decompression of the TU-cyst (and maybe a small part of solid tumor?).
Recommendation: As the tumor is strongly infiltrating the chiasdm and the hypothalamus, we would not think that surgery is to be recommended (could be harmful for the child). As the tumor did not progress significantly since the end of chemo, there is no need to start any treatment by now ("watch and wait"-strategy). We would recommend just to make clinical controls and MRI controls every 3-6 months. In case that the tumor will start to grow in future (or that other neurological deficits come), you may reconsider another chemotherapy (similiar to first or other).