Journal of Clinical Oncology, Vol 15, 2792-2799, Copyright © 1997 by American Society of Clinical Oncology
Low-grade astrocytoma: a decade of experience at St. Jude Children's Research Hospital
A Gajjar, RA Sanford, R Heideman, JJ Jenkins, A Walter, Y Li, JW Langston, M Muhlbauer, JM Boyett and LE Kun
St Jude Children's Research Hospital/Le Bonheur Children's Medical Center Brain Tumor Team, Memphis, TN 38105-2794, USA. amar.gajjar@stjude.org
PURPOSE: To evaluate the impact of primary tumor site, age at diagnosis,
extent of resection, and histology on progression-free survival (PFS) in
pediatric low-grade astrocytoma. PATIENTS AND METHODS: Medical, pathologic,
and imaging information were reviewed for 142 children (ages 2 months to 19
years) with low-grade astrocytoma treated between January 1984 and July
1994. Gross total resection (GTR) was attempted for cerebellar and cerebral
hemisphere tumors, with biopsy or less aggressive resection used
predominantly for tumors in other sites. Surgery was followed by
observation in 107 cases, radiation therapy in 31, and chemotherapy in
four. RESULTS: The overall survival rate was 90% +/- 3% (SE) at 4 years.
PFS was significantly better for patients with cerebellar and cerebral
hemisphere tumors (n = 75) than those with tumors in all other sites (P =
.0006). Within the former group, there was no significant difference in PFS
for patients in whom GTR was achieved versus those with incomplete
resections (4- year estimates, 89% and 77%, respectively). Histology
(juvenile pilocytic v astrocytoma not otherwise specified [NOS]) was not
related to PFS in an analysis that controlled for tumor site and patient
age. Patients younger than 5 years at diagnosis had a significantly poorer
PFS than older children, regardless of histology (P < .03) or tumor site
(P < .002). Treatment for progressive/recurrent disease was effective in
a majority of patients, but appeared more successful in patients with
hemispheric than thalamic or hypothalamic tumors. CONCLUSION: The overall
survival in this series of pediatric low-grade astrocytomas is excellent.
Age at diagnosis and tumor location, but not histology, had a significant
impact on PFS. Efforts to improve treatment outcome should focus on young
patients (< 5 years) and on those with central midline tumors. The
majority of patients with completely resected hemispheric tumors were
monitored without further therapy, which supports attempted GTR of cerebral
and cerebellar hemisphere low-grade astrocytoma.
This article has been cited by other articles:
|
|
|
|
 
F. Nejat, M. El Khashab, and J. T. Rutka
Initial Management of Childhood Brain Tumors: Neurosurgical Considerations
J Child Neurol,
October 1, 2008;
23(10):
1136 - 1148.
[Abstract]
[PDF]
|
|
|
|
|
|
|
K. K. Mishra, D. R. Puri, B. T. Missett, K. R. Lamborn, M. D. Prados, M. S. Berger, A. Banerjee, N. Gupta, W. M. Wara, and D. A. Haas-Kogan
The role of up-front radiation therapy for incompletely resected pediatric WHO grade II low-grade gliomas
Neuro-oncol,
April 1, 2006;
8(2):
166 - 174.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-K. Wong, Y.-M. Chang, Y. T.M. Tsang, L. Perlaky, J. Su, A. Adesina, D. L. Armstrong, M. Bhattacharjee, R. Dauser, S. M. Blaney, et al.
Expression Analysis of Juvenile Pilocytic Astrocytomas by Oligonucleotide Microarray Reveals Two Potential Subgroups
Cancer Res.,
January 1, 2005;
65(1):
76 - 84.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. C. Bowers, L. Gargan, P. Kapur, J. S. Reisch, A. F. Mulne, K. N. Shapiro, R. D. Elterman, N. J. Winick, and L. R. Margraf
Study of the MIB-1 Labeling Index as a Predictor of Tumor Progression in Pilocytic Astrocytomas in Children and Adolescents
J. Clin. Oncol.,
August 1, 2003;
21(15):
2968 - 2973.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Massimino, F. Spreafico, G. Cefalo, R. Riccardi, J. D. Tesoro-Tess, L. Gandola, D. Riva, A. Ruggiero, L. Valentini, E. Mazza, et al.
High Response Rate to Cisplatin/Etoposide Regimen in Childhood Low-Grade Glioma
J. Clin. Oncol.,
October 15, 2002;
20(20):
4209 - 4216.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S M Yule, T A H Hide, M Cranney, E Simpson, and A Barrett
Low grade astrocytomas in the West of Scotland 1987-96: treatment, outcome, and cognitive functioning
Arch. Dis. Child.,
January 1, 2001;
84(1):
61 - 64.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
A. J. Martin, W. A. Hall, H. Liu, C. H. Pozza, E. Michel, S. O. Casey, R. E. Maxwell, and C. L. Truwit
Brain Tumor Resection: Intraoperative Monitoring with High-Field-Strength MR Imaging-Initial Results
Radiology,
April 1, 2000;
215(1):
221 - 228.
[Abstract]
[Full Text]
|
|
|
|
