title: Supratentorial malignant gliomas in childhood: a single institution perspective.
abstract: BACKGROUND
  A retrospective study evaluated the clinical characteristics, prognostic factors, and outcome of patients with newly diagnosed supratentorial malignant gliomas treated with preirradiation chemotherapy.
  
  
  METHODS
  Of 41 patients with supratentorial malignant gliomas accrued between 1984-1994, all had neuroimaging documentation of the extent of resection and 37 had complete neuraxis staging prior to treatment; 80% were treated with one of a variety of neoadjuvant chemotherapy regimens.
  
  
  RESULTS
  Thirteen patients had anaplastic astrocytoma (AA), 25 had glioblastoma multiforme (GBM), and 3 had anaplastic oligodendroglioma. Gross total resection (GTR) was performed in 10 patients, subtotal resection (STR) in 22 patients, and biopsy (Bx) alone in 9 patients. For the entire group the 3-year overall and progression free survivals were 35 +/- 8% and 18 +/- 6%, respectively. Tumor recurrence was dominantly local. However, 9 patients with initially local disease failed at a distant neuraxis site, giving a 26 +/- 7% actuarial risk of dissemination at 3 years. The only significant prognostic factor was extent of tumor resection: patients who underwent GTR survived longer than those who underwent STR or Bx (P = 0.004). Histology (GBM vs. AA), age, and the use of enhanced local dose radiation therapy (brachytherapy or stereotactic irradiation) did not affect survival.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy was not associated with a survival rate significantly different from that observed in adjuvant chemotherapy studies. Systematic neuraxis staging at diagnosis and recurrence revealed a rate of neuraxis dissemination as a component of recurrence that was higher than previously reported; the utility of craniospinal irradiation in preventing isolated dissemination remains uncertain.
authors.affiliation: Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Heideman
authors.forename: J
authors.initials: J
authors.lastname: Kuttesch
authors.forename: A J
authors.initials: AJ
authors.lastname: Gajjar
authors.forename: A W
authors.initials: AW
authors.lastname: Walter
authors.forename: J J
authors.initials: JJ
authors.lastname: Jenkins
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: R A
authors.initials: RA
authors.lastname: Sanford
authors.forename: L E
authors.initials: LE
authors.lastname: Kun
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D016019:Survival Analysis