High-Grade Gliomas in Children-A Multi-Institutional Polish Study

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.

Keywords: anaplastic astrocytoma; chemotherapy; glioblastoma multiforme; high-grade glioma; pediatric oncology; radiotherapy.

Figure 1

Overall survival curves for all analyzed patients divided into subgroups based on (a) extent of resection and (b) type of chemotherapy used in primary treatment and progression free survival for all analyzed patients divided into subgroups based on (c) extent of resection and (d) use of radical radiotherapy in primary treatment. Abbreviations: OS—overall survival; PFS—progression free survival; R0—radical resection (macro- and microscopically); R1—macroscopically radical resection (but not microscopically); R2—macroscopically not-radical resection.

Figure 2

Hazard ratios for overall survival (a) and progression free survival (b) with 95% confidence intervals and p-values calculated from a multivariate Cox proportional-hazards model. Abbreviations: ECOG—Eastern Cooperative Oncology Group; R0—radical resection (macro- and microscopically); R1—macroscopically radical resection (but not microscopically); R2—macroscopically not-radical resection.