title: Long-term survival of children less than six years of age enrolled on the CCG-945 phase III trial for newly-diagnosed high-grade glioma: a report from the Children's Oncology Group.
abstract: BACKGROUND
  We analyzed the long-term survival of children under 6 years of age (<6 years) enrolled upon the Children's Cancer Group (CCG)-945 high-grade glioma (HGG) study to determine the impact of intrinsic biological characteristics as well as treatment upon both survival and quality of life (QOL) in this younger age population.
  
  
  METHODS
  Analyses were undertaken on patients <6 years with institutionally diagnosed HGG enrolled on the CCG-945 trial. Comparisons of survival were performed for patients <3 years of age (<3 years) (treated with intent to avoid irradiation) versus those between 3 and 6 years of age (3-6 years) (treated with irradiation and chemotherapy) at diagnosis. Discordance between the institutional diagnoses of HGG and consensus-reviewed diagnoses led us to perform further survival analyses for both groups. We compared the two groups of patients for biological markers, and evaluated the neuropsychological and QOL outcomes of long-term survivors.
  
  
  RESULTS
  Patients <3 years (n = 49, 19.5% of all enrolled patients) at diagnosis had a 10-year EFS and OS of 29 ± 6.5% and 37.5 ± 7%, respectively, while for patients 3-6 years (n = 34, 13.5% of all enrolled patients) 10-year EFS and OS were 35 ± 8% and 36 ± 8%, respectively. Molecular marker analysis showed that a smaller proportion of patients <3 years harbored TP53 mutations (P = 0.05). Analysis of QOL outcomes with a median length of follow-up of 15.1 years (9.5-19.2) showed comparable results.
  
  
  CONCLUSIONS
  QOL and survival data were similar for the two groups. A larger prospective study is justified to study the efficacy of chemotherapy only regimens in younger children.
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Vandana
authors.initials: V
authors.lastname: Batra
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Sands
authors.forename: Emi
authors.initials: E
authors.lastname: Holmes
authors.forename: Jeffrey Russell
authors.initials: JR
authors.lastname: Geyer
authors.forename: Allan
authors.initials: A
authors.lastname: Yates
authors.forename: Lawrence
authors.initials: L
authors.lastname: Becker
authors.forename: Peter
authors.initials: P
authors.lastname: Burger
authors.forename: Floyd
authors.initials: F
authors.lastname: Gilles
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wisoff
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Allen
authors.forename: Ian F
authors.initials: IF
authors.lastname: Pollack
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Finlay
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000401:mortality* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D011788:Quality of Life; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: high grade glioma; irradiation
references.citation: N Engl J Med. 2002 Feb 7;346(6):420-7
references.pmid: 11832530
references.citation: J Clin Oncol. 2005 Oct 20;23(30):7621-31
references.pmid: 16234523
references.citation: Pediatr Neurosurg. 2003 Sep;39(3):114-21
references.pmid: 12876389
references.citation: J Clin Oncol. 2006 Jul 20;24(21):3431-7
references.pmid: 16849758
references.citation: J Neurosurg. 1989 May;70(5):707-13
references.pmid: 2709111
references.citation: AJR Am J Roentgenol. 1986 Sep;147(3):587-92
references.pmid: 3488661
references.citation: Neurosurgery. 2002 Jun;50(6):1238-44; discussion 1244-5
references.pmid: 12015841
references.citation: Brain Pathol. 2000 Apr;10(2):249-59
references.pmid: 10764044
references.citation: J Clin Oncol. 1995 Jan;13(1):112-23
references.pmid: 7799011
references.citation: Cancer Res. 1997 Jan 15;57(2):304-9
references.pmid: 9000573
references.citation: Nature. 2012 Jan 29;482(7384):226-31
references.pmid: 22286061
references.citation: Neurosurgery. 1996 Feb;38(2):258-64
references.pmid: 8869052
references.citation: J Neurosurg. 1998 Jul;89(1):52-9
references.pmid: 9647172
references.citation: Arch Dis Child. 1987 May;62(5):461-4
references.pmid: 3606177
references.citation: J Neurooncol. 1994;21(3):255-65
references.pmid: 7699420
references.citation: Cancer Res. 2001 Oct 15;61(20):7404-7
references.pmid: 11606370
references.citation: J Pediatr Hematol Oncol. 1998 Mar-Apr;20(2):125-30
references.pmid: 9544162
references.citation: N Engl J Med. 2005 Mar 10;352(10):997-1003
references.pmid: 15758010
references.citation: J Neurooncol. 1996 May-Jun;28(2-3):245-56
references.pmid: 8832466
references.citation: Neuro Oncol. 2003 Jul;5(3):197-207
references.pmid: 12816726
references.citation: Cancer. 1995 Feb 15;75(4):1045-50
references.pmid: 7842407
references.citation: Cancer. 2001 Nov 15;92(10):2709-19
references.pmid: 11745207
references.citation: J Clin Oncol. 2003 Sep 1;21(17):3255-61
references.pmid: 12947060
references.citation: J Clin Oncol. 2004 Feb 15;22(4):706-13
references.pmid: 14966095
references.citation: J Neurooncol. 1989 Jul;7(2):165-77
references.pmid: 2550594
references.citation: Int J Radiat Oncol Biol Phys. 1981 Jun;7(6):727-36
references.pmid: 7287533
references.citation: Neurosurgery. 1987 Nov;21(5):638-44
references.pmid: 3696394
references.citation: Childs Nerv Syst. 1999 Nov;15(11-12):786-8
references.pmid: 10603023
references.citation: J Clin Oncol. 2010 Jun 20;28(18):3061-8
references.pmid: 20479398
references.citation: Cancer. 2003 Sep 15;98(6):1243-52
references.pmid: 12973849
references.citation: J Neurooncol. 2003 May;63(1):49-54
references.pmid: 12814254
references.citation: Pediatr Blood Cancer. 2007 Apr;48(4):403-7
references.pmid: 16609952