title: Secondary dissemination in children with high-grade malignant gliomas and diffuse intrinsic pontine gliomas.
abstract: In children, treatment regimen for high-grade gliomas (HGG) and diffuse intrinsic pontine gliomas (DIPG) are generally not stratified according to disease stage. The hypothesis was that secondary disseminating disease (SDD) in children with HGG is related to an even worse outcome. Description of SDD pattern was performed. In total, 270 children with newly diagnosed HGG or DIPG were eligible for retrospective analysis of SDD. Medical and computer records of these patients were reviewed for demographic characteristics, sites of dissemination, prognostic variables. Forty-six (17%) of the 270 patients had developed SDD. The median time to SDD was 8.2 months. The median overall survival (OS) after dissemination was 3.2 months. The SDD was located parenchymal in the supratentorial (34.8%), infratentorial (6.5%), supratentorial and infratentorial (19.6%), spinal (10.9%), spinal and cerebral (6.5%) regions of the CNS, or leptomeningeal (21.7%). For HGG patients, the median OS was shorter among patients with SDD than among patients without SDD (1.02 vs 1.41 years, P=0.0495). In the group of patients with SDD, patients with cerebrospinal fluid dissemination had a worse outcome compared with patients with parenchymal metastases. Summarising, SDD is a negative prognostic factor for patients with HGG outside the pons. Treatment stratification should be considered.
authors.affiliation: Department of Pediatric Hematology and Oncology, Klinik St Hedwig, University of Regensburg, Regensburg, Germany. sabine.wagner@barmherzige-regensburg.de
authors.forename: S
authors.initials: S
authors.lastname: Wagner
authors.forename: M
authors.initials: M
authors.lastname: Benesch
authors.forename: F
authors.initials: F
authors.lastname: Berthold
authors.forename: A K
authors.initials: AK
authors.lastname: Gnekow
authors.forename: S
authors.initials: S
authors.lastname: Rutkowski
authors.forename: R
authors.initials: R
authors.lastname: Sträter
authors.forename: M
authors.initials: M
authors.lastname: Warmuth-Metz
authors.forename: R-D
authors.initials: RD
authors.lastname: Kortmann
authors.forename: T
authors.initials: T
authors.lastname: Pietsch
authors.forename: J E A
authors.initials: JE
authors.lastname: Wolff
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D020295:Brain Stem Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000031:analogs & derivatives; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000556:secondary; D005910:Glioma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000556:secondary; D011149:Pons; D011878:Radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; C003726:trofosfamide