Adaption of neurosurgical resection patterns for pediatric low-grade glioma spanning two decades-Report from the German LGG-studies 1996-2018

Tibor Kelety ¹, Ulrich-Wilhelm Thomale ², Daniela Kandels ¹

¹Pediatrics and Adolescent Medicine, Swabian Children's Cancer Center, University Hospital Augsburg, Augsburg, Germany.
²Pediatric Neurosurgery, Campus Virchow Klinikum, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
³Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University, Tuebingen, Germany.
⁴Division of Pediatric Neurosurgery, Department of Neurosurgery, Heidelberg University, Heidelberg, Germany.
⁵Department of Pediatric Neurosurgery, University Children's Hospital, University of Würzburg, Würzburg, Germany.
⁶Department of Pediatric Oncology and Hematology, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
⁷Hopp Children's Cancer Center Heidelberg (KiTZ), Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg University Hospital, National Center for Tumor Diseases (NCT), Heidelberg, Germany.
⁸Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
⁹Institute of Diagnostic and Therapeutic Neuroradiology, University Hospital Würzburg, Würzburg, Germany.
¹⁰Department of Neuropathology and DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany.
¹¹Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.

⁰Pediatrics and Adolescent Medicine, Swabian Children's Cancer Center, University Hospital Augsburg, Augsburg, Germany.

Cancer Medicine +

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June 26, 2024

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Summary

Surgical resection of pediatric low-grade glioma (LGG) decreased over time, shifting towards partial resections. This trend aligns with evolving treatment guidelines, not patient factors, suggesting practice changes in neurosurgery for pediatric LGG.

Area Of Science

Pediatric neurosurgery
Oncology
Clinical trial analysis

Background

Neurosurgery is the primary treatment for pediatric low-grade glioma (LGG), with resection extent influencing treatment stratification.
Balancing surgical completeness with potential long-term quality-of-life complications is crucial in pediatric LGG management.
This study examines temporal changes in surgical resection patterns for pediatric LGG within German study cohorts.

Purpose Of The Study

To investigate if clinical considerations influenced surgical resection patterns over time in pediatric low-grade glioma (LGG) patients.
To analyze trends in the extent of neurosurgical resection in pediatric LGG across different time intervals.
To determine the relationship between patient characteristics and surgical resection extent over time.

Main Methods

Analysis of 4,270 pediatric patients from three successive German LGG studies, grouped into five time intervals (TI1-5).
Evaluation of the timing and extent of the first surgical intervention in relation to tumor site, histology, neurofibromatosis (NF1) status, sex, and age.
Binary logistic regression used to confirm temporal trends and associations with patient and tumor factors.

Main Results

The proportion of radiological LGG diagnoses increased over time (TI1: 12.6% to TI5: 21.7%).
A decrease in complete/subtotal resections and an increase in partial resections were observed from TI1 to TI5 (3440/4270 patients).
Temporal trends in resection extent were significant (p < 0.001), linked to tumor site (p < 0.001); higher age correlated with more complete resections in specific brain regions.

Conclusions

The observed decline in surgical resection extent over time was independent of patient characteristics.
This trend likely reflects the integration of updated treatment algorithms and recommendations concerning age, tumor site, and NF1 status.
Further research is necessary to elucidate the impact of surgical planning, performance, and tumor-specific factors on achieving resection goals.

Keywords:

child extent of resection low‐grade glioma neurosurgery treatment algorithm