Malignant astrocytic gliomas in children
1Department of Radiation Oncology, Columbia-Presbyterian Medical Center, New York, New York.
Insights
Pediatric glioblastoma multiforme and malignant astrocytoma survival rates varied significantly. Higher radiation doses and noncentral tumor locations improved outcomes for these aggressive brain tumors in children.
Area of Science:
- Pediatric neuro-oncology
- Radiation oncology
- Pediatric oncology
Background:
- Glioblastoma multiforme (GBM) and malignant astrocytoma are aggressive brain tumors in children.
- Long-term survival data for pediatric GBM and malignant astrocytoma treated with radiation therapy are limited.
Purpose of the Study:
- To evaluate the survival rates and prognostic factors for pediatric patients diagnosed with glioblastoma multiforme or malignant astrocytoma.
- To compare the efficacy of the Kernohan Grading System versus the Nelson criterion for grading these pediatric brain tumors.
Main Methods:
- Retrospective analysis of 54 pediatric patients (age < 20) treated between 1957 and 1980 with a minimum 5-year follow-up.
- Patients were diagnosed with either glioblastoma multiforme (Grade IV) or malignant astrocytoma (Grade III).
- All patients received radiation therapy; survival data were analyzed based on tumor grade, location, radiation dose, and grading system.
Main Results:
- Malignant astrocytoma (Grade III) showed significantly better survival rates (32% at 10 years) than glioblastoma multiforme (Grade IV, 0% at 10 years).
- Higher radiation doses (54-60 Gy) and noncentral tumor locations were associated with improved 5-year survival for both tumor types.
- Noncentral tumors had a 44% 5-year survival for malignant astrocytoma and 5% for glioblastoma multiforme; central tumors had no 5-year survivors.
Conclusions:
- Radiation dose and tumor location are critical prognostic factors for pediatric glioblastoma multiforme and malignant astrocytoma.
- The Kernohan Grading System proved more useful than the Nelson criterion for predicting prognosis in this cohort.
- While radiation therapy was generally well-tolerated acutely, long-term survivors experienced significant neurodevelopmental and endocrine sequelae.
Abstract:
Between 1957 and 1980, 54 children less than 20 years of age with a diagnosis of glioblastoma multiforme or malignant astrocytoma were treated. All patients had a minimum follow-up period of 5 years. Twenty-seven patients had glioblastoma multiforme and 27 had malignant astrocytoma. The median age was 8 years for glioblastoma multiforme patients and 10 years for malignant astrocytoma patients. All patients received radiation therapy, but two died of postoperative complications and did not complete the treatment. The Kernohan Grading System was more useful in distinguishing glioblastoma multiforme and malignant astrocytoma in terms of prognosis than was the Nelson criterion of tumor necrosis. Glioblastoma multiforme (IV) patients had survivals of 44% at 1 year, 26% at 2 years, 4% at 5 years, and 0% at 10 years. Malignant astrocytoma (III) patients had 74% survival at 1 year, 56% at 2 years, 36% at 5 years, and 32% at 10 years, (all P less than 0.05). The tumor dose and tumor location affected survival significantly. Patients with hemispheric malignant astrocytoma who received 54-60 Gy had a 60% 5-year survival rate compared to 14% for doses of 35-50 Gy. Glioblastoma multiforme patients with noncentral tumors had a 9% 5- year survival with 54-60 Gy versus 0% with 35-50 Gy. Cerebral and cerebellar hemispheric tumors did better than central tumors. There were no 5-year survivors among patients with central tumors. Noncentral tumors, on the other hand, resulted in a 44% 5-year survival for malignant astrocytoma and 5% for glioblastoma multiforme. Radiation therapy was well tolerated during the acute period. Only one patient developed a late neurologic deficit attributable to therapy. The patient had hearing loss after two courses of 50 Gy each to a temporal lobe tumor. However, six of the 11 patients who survived for 5 years or longer had intellectual, emotional, or endocrine dysfunction.
