title: Pediatric supratentorial high-grade glioma: multicenter retrospective observational study of the Korean Society for Pediatric Neuro-Oncology.
abstract: We analyzed the prognostic factors of Korean pediatric patients with supratentorial high-grade glioma (HGG). Between 1997 and 2011, 62 patients with 34 glioblastomas and 28 anaplastic gliomas were surgically operated at nine institutions. The male-to-female ratio was 33 to 29 and the median age was 12 years (range 1-18). The prognostic significance of tumor location, extent of removal, pathologic grade, treatment method, and pattern of recurrence was analyzed. The median progression-free survival (PFS) and overall survival (OS) were 9.3 (± 0.8) and 17.8 (± 1.9) months, respectively. Glioblastoma and anaplastic glioma showed OSs of 15.9 (± 1.3) and 19.6 (± 2.4) months, respectively. Based on the univariate analysis, gross total removal (GTR) and initial combined chemoradiotherapy improved PFS (p = 0.012 and p = 0.003) and OS (p = 0.030 and p = 0.013), respectively. Cerebrospinal fluid (CSF) dissemination showed poor OS (p = 0.001). Based on the multivariate analysis, GTR and initial combined chemoradiotherapy resulted in an improved PFS [(hazard ratio 0.360; 95 % CI 0.177-0.733; p = 0.005) and (hazard ratio 0.458; 95 % CI 0.230-0.911; p = 0.026), respectively]. GTR, initial combined chemoradiotherapy, and no CSF seeding resulted in an improved OS [(hazard ratio 0.417; 95 % CI 0.201-0.861; p = 0.018), (hazard ratio 0.406; 95 % CI 0.206-0.800; p = 0.009), and (hazard ratio 0.288; 95 % CI 0.148-0.563; p = 0.000), respectively]. No significant difference in PFS and OS was observed between glioblastoma and anaplastic glioma. CSF dissemination was observed in 22 patients (35.5 %) during total follow-up. Pediatric anaplastic glioma showed poor survival, similarly to glioblastoma. GTR and initial combined chemoradiotherapy were associated with improved survival.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.forename: Ji Yeoun
authors.initials: JY
authors.lastname: Lee
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Hyeon Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Chae-Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Young-Shin
authors.initials: YS
authors.lastname: Ra
authors.forename: Mee-Jeong
authors.initials: MJ
authors.lastname: Lee
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Hee-Jo
authors.initials: HJ
authors.lastname: Baek
authors.forename: Il Han
authors.initials: IH
authors.lastname: Kim
authors.forename: Kyung Duk
authors.initials: KD
authors.lastname: Park
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007723:Korea; D008297:Male; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*