High-grade gliomas in children and adolescents: is there a role for reoperation?

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  • 1 Department of Neurology and Neurosurgery, Universidade Federal de São Paulo; and
  • 2 Divisions of Neurosurgery,
  • 3 Radiology,
  • 4 Radiotherapy, and
  • 5 Neuro-Oncology, Instituto de Oncologia Pediátrica, São Paulo—SP, Brazil
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OBJECTIVE

Tumors of the CNS are the main causes of childhood cancer and have an incidence that exceeds that of leukemia. In addition, they are the leading causes of cancer-related death in childhood. High-grade gliomas account for 11% of such neoplasms and are characterized by aggressive clinical behavior and high morbidity and mortality. There is a lack of studies focusing on the factors that can prolong survival in these patients or guide therapeutic interventions. The authors aimed to investigate the factors related to longer survival durations, with a focus on reoperation for gross-total resection (GTR).

METHODS

In this retrospective cohort study, the authors analyzed 78 patients diagnosed with high-grade gliomas occurring across all CNS locations except diffuse intrinsic pontine gliomas. Patients 0 to < 19 years of age were followed up at the Pediatric Oncology Institute. Overall survival (OS) and progression-free survival (PFS) were analyzed in the context of various prognostic factors, such as age, sex, histology, extent of tumor resection, reoperation for GTR, adjuvant treatment, and treatment initiation from 2010 onward.

RESULTS

With a mean age at diagnosis of 8.7 years, 50% of the patients were female and approximately 39% underwent GTR at some point, which was already achieved in approximately 46% of them in the first surgery. The median OS was 17 months, and PFS was 10 months. In terms of median OS, the authors found no significant difference between those with reoperation for GTR and patients without GTR during treatment. Significant differences were observed in the OS in terms of the extent of resection in the first surgery, age, sex, Ki-67 expression, adjuvant treatment, and treatment initiation from 2010 onward. Furthermore, the PFS values significantly differed between those with GTR in the first surgery and Ki-67 expression ≥ 50%.

CONCLUSIONS

This study demonstrates the importance of GTR for these neoplasms, highlights the role of surgeons in its achievement in the first attempt, and questions the role of reoperation for this purpose. Finally, this study further supports the use of combined adjuvant treatment for the improvement of OS and PFS.

ABBREVIATIONS GTR = gross-total resection; OS = overall survival; PFS = progression-free survival; STR = subtotal resection.

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Contributor Notes

Correspondence Marcos Devanir Silva da Costa: Universidade Federal de São Paulo, Brazil. marcoscostaneuro@gmail.com.

INCLUDE WHEN CITING Published online December 11, 2020; DOI: 10.3171/2020.7.PEDS20389.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Ostrom QT, Gittleman H, Truitt G, CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2011-2015. Neuro Oncol. 2018;20(suppl_4):iv1iv86.

    • Search Google Scholar
    • Export Citation
  • 2

    Ostrom QT, de Blank PM, Kruchko C, Alex’s Lemonade Stand Foundation infant and childhood primary brain and central nervous system tumors diagnosed in the united states in 2007–2011. Neuro Oncol. 2015;16(suppl 10):x1x36.

    • Search Google Scholar
    • Export Citation
  • 3

    Louis DN, Perry A, Reifenberger G, The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803820.

    • Search Google Scholar
    • Export Citation
  • 4

    Gerges N, Fontebasso AM, Albrecht S, Pediatric high-grade astrocytomas: a distinct neuro-oncological paradigm. Genome Med. 2013;5(7):6677.

    • Search Google Scholar
    • Export Citation
  • 5

    El-Ayadi M, Ansari M, Sturm D, High-grade glioma in very young children: a rare and particular patient population. Oncotarget. 2017;8(38):6456464578.

    • Search Google Scholar
    • Export Citation
  • 6

    Chamdine O, Gajjar A. Molecular characteristics of pediatric high-grade gliomas. CNS Oncol. 2014;3(6):433443.

  • 7

    Paugh BS, Qu C, Jones C, Integrated molecular genetic profiling of pediatric high-grade gliomas reveals key differences with the adult disease. J Clin Oncol. 2010;28(18):30613068.

    • Search Google Scholar
    • Export Citation
  • 8

    Tamber MS, Rutka JT. Pediatric supratentorial high-grade gliomas. Neurosurg Focus. 2003;14(2):e1.

  • 9

    McCrea HJ, Bander ED, Venn RA, Sex, age, anatomic location, and extent of resection influence outcomes in children with high-grade glioma. Neurosurgery. 2015;77(3):443453.

    • Search Google Scholar
    • Export Citation
  • 10

    Lam S, Lin Y, Zinn P, Patient and treatment factors associated with survival among pediatric glioblastoma patients: a Surveillance, Epidemiology, and End Results study. J Clin Neurosci. 2018;47:285293.

    • Search Google Scholar
    • Export Citation
  • 11

    Yang T, Temkin N, Barber J, Gross total resection correlates with long-term survival in pediatric patients with glioblastoma. World Neurosurg. 2013;79(3-4):537544.

    • Search Google Scholar
    • Export Citation
  • 12

    Walston S, Hamstra DA, Oh K, A multi-institutional experience in pediatric high-grade glioma. Front Oncol. 2015;5:28.

  • 13

    Nikitović M, Stanić D, Pekmezović T, Pediatric glioblastoma: a single institution experience. Childs Nerv Syst. 2016;32(1):97103.

  • 14

    Jung TY, Lee JY, Kim DS, Pediatric supratentorial high-grade glioma: multicenter retrospective observational study of the Korean Society for Pediatric Neuro-Oncology. J Neurooncol. 2015;121(2):413419.

    • Search Google Scholar
    • Export Citation
  • 15

    Finlay JL, Boyett JM, Yates AJ, Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimen. J Clin Oncol. 1995;13(1):112123.

    • Search Google Scholar
    • Export Citation
  • 16

    Sreenivasan SA, Madhugiri VS, Sasidharan GM, Kumar RV. Measuring glioma volumes: A comparison of linear measurement based formulae with the manual image segmentation technique. J Cancer Res Ther. 2016;12(1):161168.

    • Search Google Scholar
    • Export Citation
  • 17

    Perkins SM, Rubin JB, Leonard JR, Glioblastoma in children: a single-institution experience. Int J Radiat Oncol Biol Phys. 2011;80(4):11171121.

    • Search Google Scholar
    • Export Citation
  • 18

    Boudaouara O, Charfi S, Bahri M, Pediatric high grade gliomas: Clinico-pathological profile, therapeutic approaches and factors affecting overall survival. Neurochirurgie. 2019;65(2-3):6368.

    • Search Google Scholar
    • Export Citation
  • 19

    Jakacki RI, Cohen KJ, Buxton A, Phase 2 study of concurrent radiotherapy and temozolomide followed by temozolomide and lomustine in the treatment of children with high-grade glioma: a report of the Children’s Oncology Group ACNS0423 study. Neuro Oncol. 2016;18(10):14421450.

    • Search Google Scholar
    • Export Citation
  • 20

    Muhammed A, Gaber MS, Elbeltagy M, Risk stratification of pediatric high-grade glioma: a newly proposed prognostic score. Childs Nerv Syst. 2019;35(12):23552362.

    • Search Google Scholar
    • Export Citation
  • 21

    Alkhaibary A, Alassiri AH, AlSufiani F, Alharbi MA. Ki-67 labeling index in glioblastoma; does it really matter? Hematol Oncol Stem Cell Ther. 2019;12(2):8288.

    • Search Google Scholar
    • Export Citation
  • 22

    Bloch O, Han SJ, Cha S, Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg. 2012;117(6):10321038.

    • Search Google Scholar
    • Export Citation
  • 23

    Wisoff JH, Boyett JM, Berger MS, Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children’s Cancer Group trial no. CCG-945. J Neurosurg. 1998;89(1):5259.

    • Search Google Scholar
    • Export Citation

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