Primary neurosurgery for pediatric low-grade gliomas: A prospective multi-institutional study from the children's oncology group

Jeffrey H. Wisoff, Robert A. Sanford, Linda A. Heier, Richard Sposto, Peter C. Burger, Allan J. Yates, Emiko J. Holmes, Larry E. Kun

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: Central nervous system neoplasms are the most common solid tumors in children, and more than 40% are low-grade gliomas. Variable locations, extent of resection, postoperative neurodiagnostic evaluation, and histology have confounded therapy and outcome. ObjectiveS:: To investigate disease control and survival after surgery. Methods: A prospective natural history trial from 1991 to 1996 produced a subset of patients with low-grade gliomas managed by primary surgery and subsequent observation. Patients were evaluable if eligibility, tumor location, and extent of resection were confirmed by pathological diagnosis, preoperative and postoperative imaging, and the surgeon's report. Primary end points were overall survival (OS), progression-free survival (PFS), and postprogression survival. Results: Of 726 patients enrolled, 518 were fully evaluable for analysis. The 5- and 8-year OS rates were 97% ± 0.8% and 96% ± 0.9%, respectively, and PFS rates were 80% ± 1.8% and 78% ± 2.0%. In univariate analyses, histological type, extent of residual tumor, and disease site were significantly associated with PFS and OS. In multivariate analysis, gross total resection (GTR) without residual disease was the predominant predictor of PFS. In patients with limited residual disease, 56% were free of progression at 5 years. Conclusion: GTR should be the goal when it can be achieved with an acceptable functional outcome. The variable rate of progression after incomplete resection highlights the need for new predictors of tumor behavior.

Original languageEnglish (US)
Pages (from-to)1548-1554
Number of pages7
JournalNeurosurgery
Volume68
Issue number6
DOIs
StatePublished - Jun 1 2011

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Neurosurgery
Glioma
Disease-Free Survival
Pediatrics
Survival
Survival Rate
Central Nervous System Neoplasms
Neoplasms
Residual Neoplasm
Natural History
Histology
Multivariate Analysis
Observation
Therapeutics

Keywords

  • Juvenile pilocytic astrocytoma
  • Low-grade glioma
  • Pediatric brain tumor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Wisoff, J. H., Sanford, R. A., Heier, L. A., Sposto, R., Burger, P. C., Yates, A. J., ... Kun, L. E. (2011). Primary neurosurgery for pediatric low-grade gliomas: A prospective multi-institutional study from the children's oncology group. Neurosurgery, 68(6), 1548-1554. https://doi.org/10.1227/NEU.0b013e318214a66e

Primary neurosurgery for pediatric low-grade gliomas : A prospective multi-institutional study from the children's oncology group. / Wisoff, Jeffrey H.; Sanford, Robert A.; Heier, Linda A.; Sposto, Richard; Burger, Peter C.; Yates, Allan J.; Holmes, Emiko J.; Kun, Larry E.

In: Neurosurgery, Vol. 68, No. 6, 01.06.2011, p. 1548-1554.

Research output: Contribution to journalArticle

Wisoff, JH, Sanford, RA, Heier, LA, Sposto, R, Burger, PC, Yates, AJ, Holmes, EJ & Kun, LE 2011, 'Primary neurosurgery for pediatric low-grade gliomas: A prospective multi-institutional study from the children's oncology group', Neurosurgery, vol. 68, no. 6, pp. 1548-1554. https://doi.org/10.1227/NEU.0b013e318214a66e
Wisoff, Jeffrey H. ; Sanford, Robert A. ; Heier, Linda A. ; Sposto, Richard ; Burger, Peter C. ; Yates, Allan J. ; Holmes, Emiko J. ; Kun, Larry E. / Primary neurosurgery for pediatric low-grade gliomas : A prospective multi-institutional study from the children's oncology group. In: Neurosurgery. 2011 ; Vol. 68, No. 6. pp. 1548-1554.
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