title: Late sequela after treatment of childhood low-grade gliomas: a retrospective analysis of 69 long-term survivors treated between 1983 and 2003.
abstract: The aim of the present study was to evaluate the spectrum of late effects in a large cohort of pediatric patients with low-grade gliomas (WHO grade I and II) during an observation period of 20 years. Eighty-seven patients with low-grade gliomas grouped according to tumor location (cerebellum: n=28; cerebral hemispheres: n=21; central midline: n=15; brainstem: n=12; tectum: n=5; other locations: n=6) were evaluated for tumor- and/or treatment-related late effects by analysis of medical and computer records, and personal interviews. Seventy patients underwent neurosurgery, 29 patients received additional radiotherapy and 20 additional chemotherapy. Median follow-up of survivors is 96 months with an overall survival of 79% (cerebellum: 89%; cerebral hemispheres: 95%; central midline: 80%; brainstem: 25%; tectum: 100%; other locations: 66%). Chronic medical problems (mild ataxia to multiple severe neuroendocrine deficits) are observed in 100% of patients with brainstem/central midline tumors and in 40-50% of patients with low-grade gliomas of other locations. Endocrine deficiencies were observed in 15/17 (88%) of long-term survivors who received radiotherapy. In contrast, none of the patients who underwent surgery only had endocrine deficiencies. Seven long-term survivors (10.1%) are severely disabled with permanent need of medical help. Tumor- and treatment-related late effects are common in patients with low-grade gliomas with the most severe occurring in patients with brainstem or central midline tumors. As long-term survival is excellent in patients with low-grade gliomas except for tumors located in the brainstem, future treatment studies should focus on avoiding long-term late effects.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria. martin.benesch@klinikum-graz.at
authors.forename: Martin
authors.initials: M
authors.lastname: Benesch
authors.forename: Herwig
authors.initials: H
authors.lastname: Lackner
authors.forename: Petra
authors.initials: P
authors.lastname: Sovinz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Suppan
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schwinger
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Eder
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Dornbusch
authors.forename: Andrea
authors.initials: A
authors.lastname: Moser
authors.forename: Karin
authors.initials: K
authors.lastname: Triebl-Roth
authors.forename: Christian
authors.initials: C
authors.lastname: Urban
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D001317:Austria / Q000453:epidemiology; D001932:Brain Neoplasms / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D018572:Disease-Free Survival; D004700:Endocrine System Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000150:complications / Q000628:therapy*; D006311:Hearing Disorders / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D011832:Radiation Injuries / Q000453:epidemiology; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents