Staging and Prognosis | Treatment > Surgery of Pediatric Brain Tumors  

Meeting Abstract

Impact of surgical resection on low grade gliomas of childhood: A report from the CCG9891/POG9130 low grade astrocytoma study

J. H. Wisoff, A. Sanford, E. Holmes, R. Sposto, L. Kun, L. Heier, P. Burger, A. Yates

for the Children's Oncology Group; NYU Medical Center, NY, NY; St Judes, Memphis, TN; Children's Oncology Group, Arcadia, CA; Childrens Oncology Group, Arcadia, CA; NY Hospital, New York, NY; Johns Hopkins, Baltimore, MD; Ohio, Baltimore, MD

Surgical intervention has been the primary therapy for the vast majority of low grade gliomas (LGG) of childhood.
The heterogeniety in location, treatment regimens, neurodiagnostic evaluation and the unclear natural history have resulted in extensive controversy and debate with 10 year survivals ranging from 10-94%.
The CCG9891/POG9130 protocol prospectively evaluated the impact of surgical resection on low grade gliomas of childhood.
Between 10/91 and 8/96, 726 children with newly diagnosed LGG were entered into a natural history study: central review of resection, residual disease, and pathology was confirmed in 559 patients who received only surgical resection and supportive care.
Tumor location was divided into cerebellar hemisphere, cerebellar vermis, cerebral hemisphere, midline, and chiasmatic-hypothalamic.
76.4% had juvenile pilocytic astrocytomas (JPA), 6.4% low grade astrocytoma (LGA), 7.5% ganglioglioma (GG), and 9.7% other low grade gliomas.
Extent of resection was gross total resection (GTR)-65.1%, near total resection (NTR)-17%, subtotal resection (STR)-12.4%, partial resection (PR)-3.4%, and biopsy (BX)-2.1%.
Overall survival was 96±8%.
Extent of resection, residual disease, and location were signifiant factors for progression free survival (PFS).
5 year PFS was 92±1% for GTR vs 53± 5% with NTR and 60.5±5% for £STR (p<0.0001).
By location 5 year PFS was worse in midline (59±6%) and chaismatic-hypothalamic (50±10%) compared to cerebellar hemisphere (89±2%), cerebellar vermis (84±3%), and cerebral hemisphere (80±3%) tumors (p<0.0001).
Residual disease did not affect PFS however bulky residual disease significantly decreased overall survival.
Pathology was not a significant variable for £NTR however following GTR 5 year PFS was better for GG (100%) and JPA (95±1%) compared to LGA (80±13%, p=0.0094).
Age by hemi decade was not significant.

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