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High-Grade Gliomas in Children-A Multi-Institutional Polish Study
Aleksandra Napieralska1, Aleksandra Krzywon2, Agnieszka Mizia-Malarz3
1Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland.
Insights
Pediatric high-grade gliomas (HGG) survival is poor, but radical resection and temozolomide chemotherapy improve outcomes. Immediate postoperative temozolomide and radiotherapy offer the best results for HGG patients.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Research
Background:
- High-grade gliomas (HGG) are rare in children, leading to limited treatment data.
- Understanding long-term outcomes and survival factors is crucial for improving pediatric HGG care.
Purpose of the Study:
- To investigate long-term treatment results in pediatric HGG patients.
- To identify prognostic factors associated with improved survival in this population.
Main Methods:
- Retrospective analysis of 82 pediatric HGG patients with non-brainstem primary tumors.
- Utilized Cox proportional-hazard models and Kaplan-Meier methods for survival analysis.
- Evaluated impact of surgery, chemotherapy (including temozolomide), and radiotherapy on outcomes.
Main Results:
- Overall survival rates at 1, 2, 5, and 10 years were 78%, 48%, 30%, and 17%, respectively.
- Radical (R0) resection and temozolomide-based chemotherapy correlated with better overall survival.
- R0 resection and radical radiotherapy improved progression-free survival.
Conclusions:
- Pediatric HGG patients benefit from radical surgical resection.
- Temozolomide-based chemotherapy and radical radiotherapy are key components for improving survival.
- The optimal treatment involves R0 resection with immediate postoperative temozolomide chemotherapy and radical radiotherapy.
Abstract:
Due to the rarity of high-grade gliomas (HGG) in children, data on this topic are scarce. The study aimed to investigate the long-term results of treatment of children with HGG and to identify factors related to better survival. We performed a retrospective analysis of patients treated for HGG who had the main tumor located outside the brainstem. The evaluation of factors that correlated with better survival was performed with the Cox proportional-hazard model. Survival was estimated with the Kaplan-Meier method. The study group consisted of 82 consecutive patients. All of them underwent surgery as primary treatment. Chemotherapy was applied in 93% of children with one third treated with temozolomide. After or during the systemic treatment, 79% of them received radiotherapy with a median dose of 54 Gy. Median follow-up was 122 months, and during that time, 59 patients died. One-, 2-, 5-, and 10-year overall survival was 78%, 48%, 30% and 17%, respectively. Patients with radical (R0) resection and temozolomide-based chemotherapy had better overall survival. Progression-free survival was better in patients after R0 resection and radical radiotherapy. The best outcome in HGG patients was observed in patients after R0 resection with immediate postoperative temozolomide-based chemotherapy and radical radiotherapy.
