title: Prognosis of pediatric high-grade gliomas with temozolomide treatment: a retrospective, multicenter study.
abstract: OBJECTIVE
  We analyzed the usefulness of initial or recurrent treatment of temozolomide (TMZ) in pediatric high-grade gliomas (HGGs).
  
  
  METHODS
  Between 2002 and 2010, we performed surgery on 35 patients with 17 glioblastomas, 14 anaplastic astrocytomas, 3 anaplastic oligodendrogliomas, and 1 anaplastic oligoastrocytoma. The male-to-female ratio was 21:14, and the median age was 13 years (range, 3-18 years). The mean follow-up period was 15.9 (± 1.8) months. As the TMZ treatment, 22 patients received the initial treatment and 13 patients at recurrence. We analyzed the prognostic significance of TMZ treatment, tumor location, extent of removal, pathology, and recurrence pattern.
  
  
  RESULTS
  The median progression-free survival (PFS) and overall survival (OS) were 9.7 (± 1.4) and 17.8 (± 2.5) months, respectively. Based on univariate analysis, the median PFS was 9.9 (± 1.6) months in the tumors located in the cerebral hemisphere and 5.6 (± 1.3) months in the diencephalon (p = 0.03). Median PFS was 12.5 (± 1.7) months in the initial treatment and 6.8 (±0.8) months in the recurrent treatment (p = 0.03). The median OS was 14.9 (± 2.3) months in glioblastomas and 24.4 (± 4.1) months in tumors with an anaplastic pathology (p = 0.01). The median OS was 12.1 (± 3.7) months in patients with cerebrospinal fluid (CSF) dissemination and 18.2 (± 2.9) months in patients without CSF dissemination (p = 0.02). Grades 3 and 4 treatment-related toxicity occurred in 7.7-9 % of the patients.
  
  
  CONCLUSIONS
  Initial or recurrent TMZ treatment in pediatric HGGs was safe and tolerable. Initial treatment showed improved PFS compared to recurrent treatment, and both showed similar OS.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju, South Korea.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.forename: Chae-Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Young-Shin
authors.initials: YS
authors.lastname: Ra
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Hee-Jo
authors.initials: HJ
authors.lastname: Baek
authors.forename: Hyoung-Soo
authors.initials: HS
authors.lastname: Choi
authors.forename: In-Ah
authors.initials: IA
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide