Multidisciplinary Treatment of Pediatric Low-Grade Glioma: Experience of Children Cancer Hospital of Egypt; 2007-2012

Abstract

Background: Pediatric gliomas comprise a clinically, histologically, and molecularly heterogeneous group of central nervous system tumors. The survival of children with gliomas influenced by histologic subtype, age, and extent of resection. Tumor grade emerged as the most determinant of survival except in the young age groups. The aim of this study was to evaluate the role of multidisciplinary therapeutic approach including surgery and chemotherapy, and their impact on the outcome in pediatric patients with low-grade glioma (LGG). Procedure: Study patients were prospectively enrolled onto the study. All patients were below 18-year-old, diagnosed as LGG between July 2007 and June 2012. Upfront surgical resection was attempted in all tumors other than optic pathway sites. Systemic chemotherapy was given according to CCG-A9952 protocol. Results: Total/near-total resection in 105/227 (46.3%) without adjuvant treatment, while 49/227 patients (21.5%) underwent subtotal tumor resection followed by chemotherapy for big residual (n = 26). Follow-up only was indicated for asymptomatic/small residual (n = 23). The radiological diagnosis was set in 18/227 (7.9%) patients; 13/18 had optic pathway glioma. The 3-year overall survival (OS) was 87.3% versus 65.5% event free survival (EFS) for the whole study patients with a follow-up period of 1–5 years. The OS and EFS for patients who did surgery with no adjuvant treatment (n = 128) were, respectively, 95.2% and 77.3% versus 87.4% and 65.1% for adjuvant chemotherapy group (n = 99); (P = 0.015 and P = 0.016 for OS and EFS, respectively). Conclusion: Pediatric LGGs comprise a wide spectrum of pathological and anatomical entities that carry a high rate of prolonged survival among children and adolescents. Surgical resection is the mainstay of treatment in most of tumors. Combined chemotherapy can be an acceptable alternative when surgery is not safely feasible.

Keywords

Chemotherapy - low-grade glioma - outcome - pediatric

Publication History

Article published online:
17 June 2021

• References

• 1 Duffau L, Capelle L. Preferential brain locations of low-grade gliomas. Cancer 2004; 100: 2622-6
• 2 Claus EB, Black PM. Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas: Data from the SEER program, 1973-2001. Cancer 2006; 106: 1358-63
• 3 Mandonnet E, Delattre JY, Tanguy ML, Swanson KR, Carpentier AF, Duffau H. et al. Continuous growth of mean tumor diameter in a subset of grade II gliomas. Ann Neurol 2003; 53: 524-8
• 4 Rees J, Watt H, Jäger HR, Benton C, Tozer D, Tofts P. et al. Volumes and growth rates of untreated adult low-grade gliomas indicate risk of early malignant transformation. Eur J Radiol 2009; 72: 54-64
• 5 Schiff D, Brown PD, Giannini C. Outcome in adult low-grade glioma: The impact of prognostic factors and treatment. Neurology 2007; 69: 1366-73
• 6 Soffietti R, Rudà R, Bradac GB, Schiffer D. PCV chemotherapy for recurrent oligodendrogliomas and oligoastrocytomas. Neurosurgery 1998; 43: 1066-73
• 7 van den Bent MJ, Kros JM, Heimans JJ, Pronk LC, van Groeningen CJ, Krouwer HG. et al. Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Dutch Neuro-oncology Group. Neurology 1998; 51: 1140-5
• 8 van den Bent MJ, Taphoorn MJ, Brandes AA, Menten J, Stupp R, Frenay M. et al. Phase II study of first-line chemotherapy with temozolomide in recurrent oligodendroglial tumors: The European Organization for Research and Treatment of Cancer Brain Tumor Group Study 26971. J Clin Oncol 2003; 21: 2525-8
• 9 Pace A, Vidiri A, Galiè E, Carosi M, Telera S, Cianciulli AM. et al. Temozolomide chemotherapy for progressive low-grade glioma: Clinical benefits and radiological response. Ann Oncol 2003; 14: 1722-6
• 10 Quinn JA, Reardon DA, Friedman AH, Rich JN, Sampson JH, Provenzale JM. et al. Phase II trial of temozolomide in patients with progressive low-grade glioma. J Clin Oncol 2003; 21: 646-51
• 11 Kaloshi G, Benouaich-Amiel A, Diakite F, Taillibert S, Lejeune J, Laigle-Donadey F. et al. Temozolomide for low-grade gliomas: Predictive impact of 1p/19q loss on response and outcome. Neurology 2007; 68: 1831-6
• 12 Agrasti A, Meng X. Strengh in numbers:The rising of academic statistics department in U.S 2012. p.177.
• 13 Sievert AJ, Fisher MJ. Pediatric low-grade gliomas. J Child Neurol 2009; 24: 1397-408
• 14 Whittle IR. The dilemma of low grade glioma. J Neurol Neurosurg Psychiatry 2004; 75 (02) Suppl ii31-6
• 15 Listernick R, Charrow J, Tomita T, Goldman S. Carboplatin therapy for optic pathway tumors in children with neurofibromatosis type-1. J Neurooncol 1999; 45: 185-90
• 16 Czyzyk E, Józwiak S, Roszkowski M, Schwartz RA. Optic pathway gliomas in children with and without neurofibromatosis 1. J Child Neurol 2003; 18: 471-8
• 17 Bandopadhayay P, Bergthold G, London WB, Goumnerova LC, Morales La Madrid A, Marcus KJ. et al. Long-term outcome of 4,040 children diagnosed with pediatric low-grade gliomas: An analysis of the Surveillance Epidemiology and End Results (SEER) database. Pediatr Blood Cancer 2014; 61: 1173-9
• 18 Palma L, Celli P, Mariottini A. Long-term follow-up of childhood cerebellar astrocytomas after incomplete resection with particular reference to arrested growth or spontaneous tumour regression. Acta Neurochir (Wien) 2004; 146: 581-8
• 19 Saunders DE, Phipps KP, Wade AM, Hayward RD. Surveillance imaging strategies following surgery and/or radiotherapy for childhood cerebellar low-grade astrocytoma. J Neurosurg 2005; 102 (02) Suppl 172-8
• 20 Lassaletta A, Scheinemann K, Zelcer SM, Hukin J, Wilson BA, Jabado N. et al. Phase II weekly vinblastine for chemotherapy-naïve children with progressive low-grade glioma: A Canadian pediatric brain tumor consortium study. J Clin Oncol 2016; 34: 3537-43