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Treatment of infants with malignant gliomas: the Pediatric Oncology Group experience
P K Duffner1, J P Krischer, P C Burger
1State University of New York, Buffalo School of Medicine and Biomedical Sciences 14222, USA.
Insights
Infants with malignant gliomas show promising outcomes with chemotherapy. This study suggests chemotherapy sensitivity and good prognosis in young children with these brain tumors.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Cancer Research
Background:
- Infants with malignant brain tumors generally have poor prognoses.
- Malignant gliomas represent a potential exception in this age group.
Purpose of the Study:
- To evaluate the efficacy of prolonged postoperative chemotherapy and delayed irradiation in infants with malignant gliomas.
- To assess treatment response and survival rates in this pediatric population.
Main Methods:
- Eighteen infants under 3 years with malignant gliomas were treated with cyclophosphamide and vincristine chemotherapy.
- Delayed irradiation was administered postoperatively.
- Neuroradiologic response and survival data were analyzed.
Main Results:
- Six of 10 evaluable children achieved partial responses (>50% reduction) after two chemotherapy cycles.
- Progression-free survival at 5 years was 43% +/- 23%.
- Five-year survival rate was 50% +/- 14%.
Conclusions:
- Some infant malignant gliomas demonstrate chemotherapy sensitivity.
- Treatment may be associated with a favorable prognosis, warranting further investigation into underlying biological differences.
Abstract:
Although survivals of infants with malignant brain tumors are worse than any other age group, one possible exception to this rule are the malignant gliomas. Eighteen children less than 3 years of age with malignant gliomas (glioblastoma multiforme, anaplastic astrocytoma and malignant glioma) were treated on the Pediatric Oncology Group regimen of prolonged postoperative chemotherapy and delayed irradiation, (1986-1990). Of 10 children evaluable for neuroradiologic response, 6 had partial responses (> 50% reduction) to two cycles of cyclophosphamide and vincristine. Progression free survivals at 1,3 and 5 years were 54.25% +/- 12, 43% +/- 16 and 43% +/- 23 respectively. Survivals at 5 years were 50% +/- 14. Four children were not irradiated after 24 months of chemotherapy due to parental refusal and none have developed recurrent disease. Neither degree of surgical resection, presence or absence of metastases, nor pathology influenced survival but this may reflect small sample size. This study suggests that some malignant gliomas in infants are chemotherapy sensitive and may be associated with a good prognosis. Why infants with these high-grade gliomas fare better than adults is not clear. It is likely that there is something intrinsically different about them that cannot be identified on routine pathologic examination.