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Published on: February 24, 2023
Gross total resection correlates with long-term survival in pediatric patients with glioblastoma
Tong Yang1, Nancy Temkin, Jason Barber
1Department of Neurosurgery, School of Public Health, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA. yangto@u.washington.edu
Insights
Pediatric glioblastoma survival is significantly improved with gross total resection (GTR), a surgical approach yielding longer outcomes for children with this rare central nervous system tumor.
Area of Science:
- Pediatric neuro-oncology
- Central nervous system neoplasms
- Surgical oncology
Background:
- Glioblastoma is a rare central nervous system neoplasm in pediatric patients, with distinct characteristics compared to adult forms.
- Limited research exists exclusively on pediatric glioblastoma, particularly non-brainstem types.
- Understanding clinical factors influencing outcomes in this population is crucial.
Observation:
- A retrospective study analyzed 37 pediatric patients with non-brainstem glioblastoma treated between 1982-2011.
- All patients underwent surgical intervention, with gross total resection (GTR) achieved in 45.9%.
- Post-operative radiation and chemotherapy were administered to the majority of patients.
Findings:
- The median overall survival for all pediatric patients was 18.7 months.
- Patients achieving GTR demonstrated a significantly longer median overall survival of 45.1 months compared to subtotal resection or biopsy.
- GTR was feasible primarily in tumors with superficial locations.
Implications:
- Gross total resection is a critical factor associated with improved long-term survival in pediatric patients with non-brainstem glioblastoma.
- These findings highlight the importance of surgical strategy in optimizing outcomes for this challenging pediatric malignancy.
- Further research may explore factors enabling GTR in deeper-seated tumors.
Objective:
Glioblastoma is a rare central nervous system neoplasm in pediatric patients. Few studies focused exclusively on this disease in this population. Available literature suggests that this disease behaves differently between pediatric and adult patients. We set out to study patients younger than 18 years of age, carrying the diagnosis of glioblastoma not of the brainstem, their clinical characteristics and clinical factors associated with clinical outcome.
Methods:
Thirty-seven pediatric patients with the diagnosis of glioblastoma not of the brainstem, who were treated in our institution from 1982-2011, were identified and studied retrospectively.
Results:
All patients underwent surgical intervention. Seventeen patients (45.9%) had gross total resection (GTR). Thirteen patients (35.1%) had subtotal resection and seven (18.9%) had biopsy. After surgery, 35 patients received radiation therapy (94.6%) and 34 patients (91.9%) received chemotherapy (various agents depending on the institutional protocols established at the time of treatment and family choice). Median follow-up time was 17.5 months, ranging from 0.5-186 months. The median overall survival is 18.7 months (95% confidence interval 15.7-21.8 months). The survival rate at 1, 2, and 5 years is 63.9%, 44.5%, and 17.6%, respectively. The median overall survival for patients with GTR is 45.1 months (95% confidence interval 27.5-62.8 months), 8.7 or 11.5 months for patients with subtotal resection or biopsy, respectively. GTR was accomplished only in patients with superficially located tumors.
Conclusions:
GTR significantly associates with long-term survival in our population of pediatric patients with glioblastoma not of the brainstem.
