LOW-GRADE GLIOMAS IN CHILDREN - REVIEW OF 51 CASES TREATED IN A SINGLE-CENTER

Low-grade gliomas are the most common brain tumors in children. Total surgical excision should always be sought but may be unfeasible if the tumor is in a critical site or has ill-defined margins. The role of a djunctive treatments needs to be clarified based on long-term tumoral behavior and on adverse treatment effects. Fifty-one cases of pediatri c low-grade glioma treated in a single center between 1986 and 1995 we re reviewed with the goal of looking for correlations between outcomes and clinical, histological, and therapeutic parameters. Median age wa s seven years, Supratentorial, infratentorial, and spinal tumors contr ibuted 63%, 31%, and 6% of cases, respectively. Juvenile pilocytic ast rocytoma was the most common histologic type (53%). Surgical excision was considered total or subtotal, partial, or limited to a simple biop sy in 37%, 30%, and 37% of cases, respectively. There were no recurren ces in the 17 patients who had total or subtotal excision. Of the 14 p atients who had partial excision, three developed a recurrence and two died. Five of the 15 biopsied patients had a recurrence despite nonsu rgical treatment that usually combined chemotherapy and radiation ther apy. The chemotherapy response rate was 39%. Survival and progression- free survival rates were 86% and 82%, respectively, after a median fol low-up of 84 months. Total surgical excision was the only significant prognostic factor in the univariate analysis. The role of initial radi ation therapy remains to be determined. Chemotherapy allowed to postpo ne radiation therapy in two of four patients. Survival rates in patien ts who had partial excision were similar to those reported in studies of patients who received adjunctive therapy only at the time of the re currence. Our data confirm the importance of total surgical excision, which should be the goal in every case and obviates the need for adjun ctive therapy. They also demonstrate that chemotherapy can provide a c omplete remission and/or allow to postpone radiation therapy.