title: Gross total resection correlates with long-term survival in pediatric patients with glioblastoma.
abstract: OBJECTIVE
  Glioblastoma is a rare central nervous system neoplasm in pediatric patients. Few studies focused exclusively on this disease in this population. Available literature suggests that this disease behaves differently between pediatric and adult patients. We set out to study patients younger than 18 years of age, carrying the diagnosis of glioblastoma not of the brainstem, their clinical characteristics and clinical factors associated with clinical outcome.
  
  
  METHODS
  Thirty-seven pediatric patients with the diagnosis of glioblastoma not of the brainstem, who were treated in our institution from 1982-2011, were identified and studied retrospectively.
  
  
  RESULTS
  All patients underwent surgical intervention. Seventeen patients (45.9%) had gross total resection (GTR). Thirteen patients (35.1%) had subtotal resection and seven (18.9%) had biopsy. After surgery, 35 patients received radiation therapy (94.6%) and 34 patients (91.9%) received chemotherapy (various agents depending on the institutional protocols established at the time of treatment and family choice). Median follow-up time was 17.5 months, ranging from 0.5-186 months. The median overall survival is 18.7 months (95% confidence interval 15.7-21.8 months). The survival rate at 1, 2, and 5 years is 63.9%, 44.5%, and 17.6%, respectively. The median overall survival for patients with GTR is 45.1 months (95% confidence interval 27.5-62.8 months), 8.7 or 11.5 months for patients with subtotal resection or biopsy, respectively. GTR was accomplished only in patients with superficially located tumors.
  
  
  CONCLUSIONS
  GTR significantly associates with long-term survival in our population of pediatric patients with glioblastoma not of the brainstem.
authors.affiliation: Department of Neurosurgery, School of Public Health, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA. yangto@u.washington.edu
authors.forename: Tong
authors.initials: T
authors.lastname: Yang
authors.forename: Nancy
authors.initials: N
authors.lastname: Temkin
authors.forename: Jason
authors.initials: J
authors.lastname: Barber
authors.forename: J Russell
authors.initials: JR
authors.lastname: Geyer
authors.forename: Sarah
authors.initials: S
authors.lastname: Leary
authors.forename: Samuel
authors.initials: S
authors.lastname: Browd
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Ojemann
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
mesh_terms: D000293:Adolescent; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000473:pathology / Q000601:surgery*; D006261:Headache / Q000209:etiology; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D013534:Survival; D016896:Treatment Outcome