TY - JOUR
T1 - Primary neurosurgery for pediatric low-grade gliomas
T2 - A prospective multi-institutional study from the children's oncology group
AU - Wisoff, Jeffrey H.
AU - Sanford, Robert A.
AU - Heier, Linda A.
AU - Sposto, Richard
AU - Burger, Peter C.
AU - Yates, Allan J.
AU - Holmes, Emiko J.
AU - Kun, Larry E.
PY - 2011/6
Y1 - 2011/6
N2 - 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.
AB - 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.
KW - Juvenile pilocytic astrocytoma
KW - Low-grade glioma
KW - Pediatric brain tumor
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U2 - 10.1227/NEU.0b013e318214a66e
DO - 10.1227/NEU.0b013e318214a66e
M3 - Article
C2 - 21368693
AN - SCOPUS:79955884572
SN - 0148-396X
VL - 68
SP - 1548
EP - 1554
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -