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Wagner MW, Jabehdar Maralani P, Bennett J, Nobre L, Lim-Fat MJ, Dirks P, Laughlin S, Tabori U, Ramaswamy V, Hawkins C, Ertl-Wagner BB. Brain Tumor Imaging in Adolescents and Young Adults: 2021 WHO Updates for Molecular-based Tumor Types. Radiology 2024; 310:e230777. [PMID: 38349246 DOI: 10.1148/radiol.230777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Published in 2021, the fifth edition of the World Health Organization (WHO) classification of tumors of the central nervous system (CNS) introduced new molecular criteria for tumor types that commonly occur in either pediatric or adult age groups. Adolescents and young adults (AYAs) are at the intersection of adult and pediatric care, and both pediatric-type and adult-type CNS tumors occur at that age. Mortality rates for AYAs with CNS tumors have increased by 0.6% per year for males and 1% per year for females from 2007 to 2016. To best serve patients, it is crucial that both pediatric and adult radiologists who interpret neuroimages are familiar with the various pediatric- and adult-type brain tumors and their typical imaging morphologic characteristics. Gliomas account for approximately 80% of all malignant CNS tumors in the AYA age group, with the most common types observed being diffuse astrocytic and glioneuronal tumors. Ependymomas and medulloblastomas also occur in the AYA population but are seen less frequently. Importantly, biologic behavior and progression of distinct molecular subgroups of brain tumors differ across ages. This review discusses newly added or revised gliomas in the fifth edition of the CNS WHO classification, as well as other CNS tumor types common in the AYA population.
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Affiliation(s)
- Matthias W Wagner
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Pejman Jabehdar Maralani
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Julie Bennett
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Liana Nobre
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Mary Jane Lim-Fat
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Peter Dirks
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Suzanne Laughlin
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Uri Tabori
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Vijay Ramaswamy
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Cynthia Hawkins
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
| | - Birgit B Ertl-Wagner
- From the Division of Neuroradiology, Department of Diagnostic Imaging (M.W.W., S.L., B.B.E.W.), Division of Hematology/Oncology (J.B., L.N., U.T., V.R.), Department of Paediatric Laboratory Medicine, Division of Pathology (C.H.), Division of Neurosurgery (P.D.), and Division of Pediatric Neuroradiology (M.W.W.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; Neurosciences & Mental Health Research Program, SickKids Research Institute, Toronto, Canada (M.W.W., B.B.E.W.); Department of Medical Imaging, University of Toronto, Toronto, Canada (M.W.W., P.J.M., B.B.E.W.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany (M.W.W.); Divisions of Neuroradiology (P.J.M.) and Neurooncology (M.J.L.F.), Sunnybrook Health Science Centre, Toronto, Canada; and Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada (J.B.)
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3
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Thomale UW, Gnekow AK, Kandels D, Bison B, Hernáiz Driever P, Witt O, Pietsch T, Koch A, Capper D, Kortmann RD, Timmermann B, Harrabi S, Simon M, El Damaty A, Krauss J, Schuhmann MU, Aigner A. Long-term follow-up of surgical intervention pattern in pediatric low-grade gliomas: report from the German SIOP-LGG 2004 cohort. J Neurosurg Pediatr 2022; 30:316-329. [PMID: 35901673 DOI: 10.3171/2022.6.peds22108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgical treatment is an integral part of the treatment algorithms for pediatric low-grade glioma (LGG), yet patterns of surgical procedures are rarely challenged. The objective of this study was to evaluate surgical treatment patterns in pediatric LGG. METHODS The German Societé Internationale d'Oncologie Pédiatrique (SIOP)-LGG 2004 cohort was analyzed to identify relevant patient and tumor characteristics associated with time to death, next surgery, number of resections, and radiological outcome. RESULTS A total of 1271 patients underwent 1713 neurosurgical interventions (1 intervention in 947, 2 in 230, 3 in 70, and 4-6 in 24). The median age of the study population was 8.57 years at first surgery, and 46.1% were female. Neurofibromatosis type 1 (NF1) was found in 4.4%, and 5.4% had tumor dissemination. Three hundred fifty-four patients (27.9%) had chemotherapy and/or radiotherapy. The cumulative incidence of second surgery at 10 years was 26%, and was higher for infants, those with spinal and supratentorial midline (SML) tumors, and those with pilomyxoid astrocytomas. The hazard ratio for subsequent surgery was higher given dissemination and noncomplete initial resection, and lower for caudal brainstem and SML tumors. Among 1225 patients with fully documented surgical records and radiological outcome, 613 reached complete remission during the observation period, and 50 patients died. Patients with pilocytic astrocytoma had higher chances for a final complete remission, whereas patients with initial partial or subtotal tumor resection, dissemination, NF1, or primary tumor sites in the spinal cord and SML had lower chances. CONCLUSIONS Neurosurgery is a key element of pediatric LGG treatment. In almost 50% of the patients, however, at least some tumor burden will remain during long-term follow-up. This study found that most of these patients reached a stable disease status without further surgeries. Multidisciplinary team decisions must balance the goal of complete resection, risk factors, repeated surgeries, and possible treatment alternatives in a wide range of heterogeneous entities. Procedural details and neurological outcome should be recorded to better assess their impact on long-term outcome.
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Affiliation(s)
- Ulrich-Wilhelm Thomale
- 1Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Astrid K Gnekow
- 2Pediatric and Adolescent Medicine, Swabian Children's Cancer Research Center, Medical Faculty, University of Augsburg
| | - Daniela Kandels
- 2Pediatric and Adolescent Medicine, Swabian Children's Cancer Research Center, Medical Faculty, University of Augsburg
| | - Brigitte Bison
- 3Institute of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg
- 4Institute of Diagnostic and Interventional Neuroradiology, Medical Faculty, University of Augsburg
| | - Pablo Hernáiz Driever
- 5Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Olaf Witt
- 6Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ), and Heidelberg University Hospital, Heidelberg
| | - Torsten Pietsch
- 7Department of Neuropathology, DGNN Brain Tumor Reference Centre, University of Bonn Medical Centre, Bonn
| | - Arend Koch
- 8Institute for Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - David Capper
- 8Institute for Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | | | - Beate Timmermann
- 10Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), German Cancer Consortium (DKTK), Essen
| | - Semi Harrabi
- 11Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg
| | - Michèle Simon
- 5Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Ahmed El Damaty
- 12Division of Pediatric Neurosurgery, Department of Neurosurgery, Heidelberg University Hospital, Heidelberg
| | - Juergen Krauss
- 13Department of Pediatric Neurosurgery, University Children's Hospital, University of Würzburg
| | - Martin U Schuhmann
- 14Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen; and
| | - Annette Aigner
- 15Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
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5
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Liu Z, Feng S, Li J, Cao H, Huang J, Fan F, Cheng L, Liu Z, Cheng Q. The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma. Front Oncol 2021; 11:566972. [PMID: 33842307 PMCID: PMC8027112 DOI: 10.3389/fonc.2021.566972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The role of surgical resection in the treatment of brainstem glioma (BSG) is poorly understood. For pediatric low-grade (LGBSG) group, several monocentric small-scale retrospective studies reported contradictory conclusions. And there was no clinical study focused on surgical resection for adult or pediatric high-grade (HG) patient groups. This study aims to illustrate whether surgical resection and adjuvant therapy provide survival benefits for patients with histologically confirmed BSG. Patients and Methods This retrospective cohort study included 529 patients with histologically confirmed BSG in Surveillance Epidemiology and End Results (SEER) database from 2006-2015. Patients were divided into four groups by age and World Health Organization (WHO) grade. Kaplan-Meier curves of CSS were plotted by different treatment options to compare the survival probability. Univariate and multivariable analyses were then conducted to determine the prognosis effects of surgical resection and adjuvant therapy on cancer specific survival (CSS). All analyses were done in four different groups separately. Results The final sample included 529 patients. The entire study population was divided into groups of pediatric LG (n=236, 44.6%), pediatric HG (n=37, 7.0%), adult LG (n=204, 38.6%) and adult HG (n=52, 9.8%). 52.7% (n=144) of pediatric patients had pilocytic astrocytoma and 45.3% (n=116) of adult patients had ependymoma. Pediatric LGBSG group had the highest gross total resection (GTR) rate (61.4%) and 5-year CSS rate (88.6%). Kaplan-Meier curves of pediatric LGBSG group revealed that patients treated with GTR had significantly better survival probability (P=0.033). Multivariable analysis identified GTR as independently significant predictor for prolonged CSS in pediatric LGBSG group (HR0.29, 95%CI 0.11-0.78, P=0.015); Surgical resection showed no relation to CSS in other patient groups. Kaplan-Meier curves of adult HGBSG group showed that patients treated with both RT and CT in adult HGBSG group had the best survival probability (P=0.02). However, multivariable analysis showed the combination of radiotherapy (RT) and chemotherapy (CT) was not significantly related to better CSS in adult HGBSG group (HR0.35, 95%CI 0.11-1.09, P=0.070). Adjuvant therapy didn’t associate with better CSS in other patient groups. Conclusion Pediatric LGBSG group had the highest GTR rate and the most favorable clinical outcome. GTR can provide significant survival benefits for pediatric LGBSG group.
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Affiliation(s)
- Zhuoyi Liu
- Department of Anesthesiology, Xiangya Hospital, Center South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Songshan Feng
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Molecular Radiation Oncology of Hunan Province, Changsha, China
| | - Jing Li
- Department of Rehabilitation, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Cao
- Department of Psychiatry, The Second People's Hospital of Hunan Province, The Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jun Huang
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fan Fan
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Center for Medical Genetics & Hunan Provincial Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Li Cheng
- Department of Emergency, Fengyang County Hospital of Traditional Chinese Medicine, Fengyang, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Quan Cheng
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
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7
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Kandels D, Pietsch T, Bison B, Warmuth-Metz M, Thomale UW, Kortmann RD, Timmermann B, Hernáiz Driever P, Witt O, Schmidt R, Gnekow AK. Loss of efficacy of subsequent nonsurgical therapy after primary treatment failure in pediatric low-grade glioma patients-Report from the German SIOP-LGG 2004 cohort. Int J Cancer 2020; 147:3471-3489. [PMID: 32580249 DOI: 10.1002/ijc.33170] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
First-line treatment of pediatric low-grade glioma using surgery, radio- or chemotherapy fails in a relevant proportion of patients. We analyzed efficacy of subsequent surgical and nonsurgical therapies of the German cohort of the SIOP-LGG 2004 study (2004-2012, 1558 registered patients; median age at diagnosis 7.6 years, median observation time 9.2 years, overall survival 98%/96% at 5/10 years, 15% neurofibromatosis type 1 [NF1]). During follow-up, 1078/1558 patients remained observed without (n = 217), with 1 (n = 707), 2 (n = 124) or 3 to 6 (n = 30) tumor volume reductions; 480/1558 had 1 (n = 332), 2 (n = 80), 3 or more (n = 68) nonsurgical treatment-lines, accompanied by up to 4 tumor-reductive surgeries in 215/480; 265/480 patients never underwent any neurosurgical tumor volume reduction (163/265 optic pathway glioma). Patients with progressing tumors after first-line adjuvant treatment were at increased risk of suffering further progressions. Risk factors were young age (<1 year) at start of treatment, tumor dissemination or progression within 18 months after start of chemotherapy. Progression-free survival rates declined with subsequent treatment-lines, yet remaining higher for patients with NF1. In non-NF1-associated tumors, vinblastine monotherapy vs platinum-based chemotherapy was noticeably less effective when used as second-line treatment. Yet, for the entire cohort, results did not favor a certain sequence of specific treatment options. Rather, all can be aligned as a portfolio of choices which need careful balancing of risks and benefits. Future molecular data may predict long-term tumor biology.
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Affiliation(s)
- Daniela Kandels
- Swabian Children's Cancer Center, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, Bonn, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Olaf Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ), and Heidelberg University Hospital, Heidelberg, Germany
| | - René Schmidt
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Astrid K Gnekow
- Swabian Children's Cancer Center, Medical Faculty, University of Augsburg, Augsburg, Germany
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