The purpose of this review is to highlight some of the pertinent concepts and controversies surrounding the diagnosis and treatment of pediatric supratentorial high-grade gliomas. Unlike the adult counterparts, pediatric high-grade gliomas are likely derived from distinct cytogenetic and molecular alterations. Surgery has been shown to play a role in extending patient survival. Some success is associated with the provision of chemotherapy. Radiotherapy remains an important adjunct in children older than age 3 years. The challenges involved in improving the poor prognosis of children in whom these very aggressive tumors have been diagnosed will be discussed, as well as some of the novel approaches being investigated to improve patient survival and quality of life.
Abbreviations used in this paper:AA = anaplastic glioma; CCG = Children's Cancer Group; CNS = central nervous system; CT = computerized tomography; GBM = glioblastoma multiforme; MR = magnetic resonance; NF1 = neurofibromatosis Type 1; pCV = prednisone; CCNU (lomustine) vincristine; PFS = progression free survival; POG = Pediatric Oncology Group; QOL = quality of life.
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Address reprint requests to: James T. Rutka, M.D., Ph.D., F.R.C.S.(C), Division of Neurosurgery, The Hospital for Sick Children, Suite 1504, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. email: