title: Glioblastoma in children: a single-institution experience.
abstract: OBJECTIVE
  Current treatment recommendations for pediatric glioblastoma include surgery, chemotherapy, and radiation therapy. However, even with this multispecialty approach, overall survival remains poor. To assess outcome and evaluate treatment-related prognostic factors, we retrospectively reviewed the experience at our institution.
  
  
  METHODS
  Twenty-four glioblastoma patients under the age of 21 were treated with radiation therapy with curative intent at Washington University, St. Louis, from 1970 to 2008. Patients underwent gross total resection, subtotal resection or biopsy alone. Fourteen (58%) of the patients received chemotherapy. All patients received radiation therapy. Radiation consisted of whole-brain radiation therapy in 7 (29%) patients with a median dose of 50.4 Gy. Seventeen (71%) patients received three-dimensional conformal radiation therapy with a median dose of 54 Gy.
  
  
  RESULTS
  Median follow-up was 12.5 months from diagnosis. One and 2-year overall survival rates were 57% and 32%, respectively. Median overall survival was 13.5 months. There were no differences in overall survival based on patients' age, race, gender, tumor location, radiation volume, radiation dose, or the use of chemotherapy. There was a significant improvement in overall survival for patients in whom gross total resection was achieved (p = 0.023). Three patients were alive 5 years after gross total resection, and 2 patients were alive at 10 and 24 years after diagnosis.
  
  
  CONCLUSIONS
  Survival for children with glioblastoma remains poor. Data from this and other studies demonstrate the importance of achieving a gross total resection. Continued investigation into new treatment options is needed in an attempt to improve outcome for these patients.
authors.affiliation: Department of Radiation Oncology and Mallinkrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Perkins
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Rubin
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
authors.forename: Issam
authors.initials: I
authors.lastname: El Naqa
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Michalski
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Simpson
authors.forename: David L
authors.initials: DL
authors.lastname: Limbrick
authors.forename: Tae S
authors.initials: TS
authors.lastname: Park
authors.forename: David B
authors.initials: DB
authors.lastname: Mansur
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008923:Missouri; D017063:Outcome Assessment, Health Care; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult