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Near complete surgical resection predicts a favorable outcome
in pediatric patients with nonbrainstem, malignant gliomas: results from a
single center in the magnetic resonance imaging era
Bucci MK, Maity A, Janss AJ, Belasco JB, Fisher MJ, Tochner ZA, Rorke L,
Sutton LN, Phillips PC, Shu HK
Department of Radiation Oncology, Hospital of the University of Pennsylvania,
Philadelphia, Pennsylvania 19104, USA.
Background. Because few reports on outcome in patients with pediatric malignant
gliomas during the magnetic resonance imaging era were available, the authors
studied the outcomes of children with these tumors at their institution.
Methods. The medical records of 39 patients with nonbrainstem, malignant gliomas
who were treated at the Hospital of the University of Pennsylvania/Children's
Hospital of Philadelphia between February 1, 1989 and December 31, 2000 were
reviewed retrospectively.
Magnetic resonance imaging was used to assess tumors
at presentation and at follow-up.
Progression-free survival (PFS) and overall
survival (OS) were determined using the Kaplan-Meier method.
Univariate and
multivariate analyses were performed using a Cox proportional hazards model.
Results. The median follow-up for the 14 surviving patients was 47.6 months.
The
median PFS for all patients was 12.2 months, and the median OS for all patients
was 21.3 months.
The extent of surgery was the strongest prognostic factor for
predicting outcomes in these patients, with a median survival of 122.2 months in
patients who underwent macroscopic total resection compared with 14.1 months in
patients who had significant residual disease after surgery.
In univariate
analyses, other than the extent of surgery, only the absence of visual symptoms
at diagnosis significantly predicted improved OS.
Local control was improved for
patients who underwent better resection and had smaller tumors.
In multivariate
analyses, although the extent of surgery continued to predict outcomes
significantly, histologic grade, which was not significant in the univariate
analysis, also was significant.
Conclusions. Children with malignant gliomas
appeared to fare better than their adult counterparts.
Because the extent of
resection was one of the strongest predictors of outcome, the authors concluded
that the optimal therapy for these patients would include the maximal possible
resection.
Copyright 2004 American Cancer Society.
PMID: 15305415 [PubMed - in process]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15305415&dopt=Abstract
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