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Pediatric glioblastoma: clinico-radiological profile and factors affecting the outcome
Kuntal Kanti Das1, Anant Mehrotra, Anup P Nair
1Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Pediatric glioblastomas have longer survival rates compared to adults. Aggressive surgical tumor resection is the most significant factor influencing survival outcomes in children with glioblastoma.
Area of Science:
- Pediatric neuro-oncology
- Surgical oncology
- Clinical outcomes research
Background:
- Pediatric glioblastoma is a rare brain tumor with poorly defined clinical and pathological profiles.
- Prognostic factors for pediatric glioblastoma survival are less established than in adult cases.
Purpose of the Study:
- To analyze clinico-radiological, pathological, and treatment data for pediatric glioblastoma.
- To identify prognostic factors influencing survival in pediatric glioblastoma patients.
Main Methods:
- Retrospective study of 65 pediatric patients (age ≤ 18 years) with intracranial glioblastoma diagnosed between 1995 and 2011.
- Data collected included clinical, radiological, pathological, treatment, and follow-up information.
- Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method.
Main Results:
- The leading symptoms were headache (78%), seizures (65%), and focal deficits (47%).
- Gross total tumor excision was achieved in 66% of patients.
- Median PFS was 10 months and median OS was 20 months.
- Extent of tumor resection was an independent predictor of survival (p=0.002).
Conclusions:
- Pediatric glioblastomas demonstrate longer PFS and OS compared to adult counterparts.
- The extent of tumor resection is the strongest predictor of survival in pediatric glioblastoma.
- Aggressive surgical resection may lead to improved outcomes for children with glioblastoma.
Background And Purpose:
Glioblastoma in the pediatric age group is relatively rare. As a result, it has been difficult to deduce any consistent clinico-radiological and pathological profiles on these patients. Also, the prognostic factors affecting the survival in pediatric glioblastoma are not as well defined as in adults.
Patients And Methods:
In this retrospective series, 65 pediatric patients (age ≤ 18 years) from January 1995 to December 2011 with histopathologically proven diagnosis of intracranial glioblastoma were studied. Clinico-radiological, pathological, treatment, and follow-up data were collected. Progression-free and overall survivals were assessed using the Kaplan-Meier method.
Results:
The male-to-female ratio was 2.6:1 with a mean age of 13.29 ± 4.53 years (range 2-18 years). Headache with or without vomiting (n = 51, 78 %), followed by seizures (n = 42, 65 %), and focal deficits (n = 31, 47 %) were the leading symptoms. Forty-nine (75 %) patients had tumors located superficially, whereas there were 16 patients with deeply located glioblastomas (25 %). Gross total tumor excision was achieved in 43 (66 %) patients, while the remaining patients had incomplete excision (n = 22, 34 %). Mean follow-up was 17.7 months (range 1.5-119 months). The median progression-free and overall survivals were 10 and 20 months, respectively. Extent of resection was found to be the independent predictor of survival (p value = 0.002).
Conclusion:
Pediatric glioblastomas are associated with longer progression-free as well as overall survivals. Extent of tumor resection is the strongest predictor of survival in pediatric glioblastoma. Hence, an aggressive surgical resection may fetch a better outcome in children with glioblastoma.
