SUPRATENTORIAL MALIGNANT GLIOMAS IN CHILDHOOD - A SINGLE INSTITUTION PERSPECTIVE

BACKGROUND. A retrospective study evaluated the clinical characteristi cs, prognostic factors, and outcome of patients with newly diagnosed s upratentorial malignant gliomas treated with preirradiation chemothera py. METHODS. Of 41 patients with supratentorial malignant gliomas accr ued between 1984-1994, all had neuroimaging documentation of the exten t of resection and 37 had complete neuraxis staging prior to treatment ; 80% were treated with one of a variety of neoadjuvant chemotherapy r egimens. RESULTS. Thirteen patients had anaplastic astrocytoma (AA), 2 5 had glioblastoma multiforme (GBM), and 3 had anaplastic oligodendrog lioma. Gross total resection (GTR) was performed in 10 patients, subto tal resection (STR) in 22 patients, and biopsy (Bx) alone in 9 patient s. For the entire group the 3-year overall and progression free surviv als were 35 +/- 8% and 18 +/- 6%, respectively. Tumor recurrence was d ominantly local. However, 9 patients with initially local disease fail ed at a distant neuraxis site, giving a 26 +/- 7% actuarial risk of di ssemination at 3 years. The only significant prognostic factor was ext ent of tumor resection: patients who underwent GTR survived longer tha n those who underwent STR or Bx (P = 0.004). Histology (GBM vs. AA), a ge, and the use of enhanced local dose radiation therapy (brachytherap y or stereotactic irradiation) did not affect survival. CONCLUSIONS. N eoadjuvant chemotherapy was not associated with a survival rate signif icantly different from that observed in adjuvant chemotherapy studies. Systematic neuraxis staging at diagnosis and recurrence revealed a ra te of neuraxis dissemination as a component of recurrence that was hig her than previously reported; the utility of craniospinal irradiation in preventing isolated dissemination remains uncertain. (C) 1997 Ameri can Cancer Society.