Malignant astrocytic gliomas 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.