title: Gliomatosis cerebri: 20 years of experience at the Children's Hospital of Philadelphia.
abstract: BACKGROUND
  Gliomatosis cerebri (GC) is a rare and typically fatal glial neoplasm of the central nervous system. In this report, the authors describe the largest cohort of children to date with GC and explore relations between potential prognostic factors, treatment, and survival.
  
  
  METHODS
  Imaging, pathologic, and outcome data were reviewed from 13 patients who were diagnosed with GC and were treated at the Children's Hospital of Philadelphia (CHOP) between 1982 and 2005. All patients had GC confirmed by biopsy. Twelve patients received cranial irradiation, and 8 of those patients received adjuvant chemotherapy. A single patient age 1 year received chemotherapy alone. A review of the literature identified 51 pediatric patients with GC.
  
  
  RESULTS
  The progression-free survival rate in this study was 13% (range, 1.5-43 months), and the overall survival (OS) rate was 64% (range, 6.5-67 months) at 2 years. OS was significantly shorter for patients who presented in the first decade of life (P = .04). The time to progression was prolonged significantly for patients who had no evidence of tumor enhancement on imaging studies (P = .03). When survival data from patients reported in the literature were combined with the CHOP cohort, treatment prolonged OS significantly (P = .003).
  
  
  CONCLUSIONS
  The outcome of pediatric patients with GC was extremely poor; however, the current results indicated that treatment may prolong OS. Age < 10 years and contrast enhancement on magnetic resonance imaging studies at diagnosis may be risk factors for shorter survival in pediatric patients with GC.
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. greg.armstrong@stjude.org
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Peter C
authors.initials: PC
authors.lastname: Phillips
authors.forename: Lucy B
authors.initials: LB
authors.lastname: Rorke-Adams
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Judkins
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018302:Neoplasms, Neuroepithelial / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015143:Philadelphia; D016896:Treatment Outcome