title: High-grade astrocytoma in very young children.
abstract: BACKGROUND
  High-grade astrocytomas are rare in young children, but have been reported to have a better prognosis than similar tumors in older patients.
  
  
  METHODS
  We retrospectively reviewed the clinical characteristics, survival, and long-term sequelae for patients younger than 3 years old with high-grade astrocytoma, treated at a single institution between 1984 and 2005.
  
  
  RESULTS
  Sixteen patients were included. Histology included anaplastic astrocytoma (n = 9), glioblastoma multiforme (n = 5), and malignant glioma (n = 2). All patients underwent biopsy or resection, followed by chemotherapy. Six patients received scheduled irradiation and six were irradiated at the time of disease progression. Ten patients are alive at a median follow-up of 11.6 years (range, 1.7-21.6 years). 5-year overall survival (OS) was 66.3% (SE 12.2%), and 5-year event-free survival (EFS) was 28.6% (SE 12.1%). Age at diagnosis was a significant predictor of the hazard of death in a Cox model (HR 2.871, 95%CI 1.015-8.123). Gender and histology did not predict OS or EFS. Trends toward improved OS were detected for patients with hemispheric tumors and those undergoing complete resection. All evaluable survivors (n = 9) had some neurocognitive impairment, with estimated overall cognitive ability ranging from significantly delayed to average; all survivors attending school (n = 5) performed below grade level on achievement testing. Seven of nine evaluable survivors had endocrine dysfunction.
  
  
  CONCLUSIONS
  Young children with high-grade astrocytoma have better long-term overall survival than older patients, but recurrence is common, and most children require irradiation. Long-term complications are frequent and often severe.
authors.affiliation: Division of Neuro-Oncology, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. robert.sanders@stjude.org
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sanders
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kocak
authors.forename: Peter C
authors.initials: PC
authors.lastname: Burger
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
authors.forename: Alberto
authors.initials: A
authors.lastname: Broniscer
mesh_terms: D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001254:Astrocytoma / Q000175:diagnosis / Q000628:therapy*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome