title: Outcome of young children with high-grade glioma treated with irradiation-avoiding intensive chemotherapy regimens: Final report of the Head Start II and III trials.
abstract: To report the final analysis of survival outcomes for children with newly diagnosed high-grade glioma (HGG) treated on the "Head Start" (HS) II and III protocols with chemotherapy and intent to avoid irradiation in children <6 years old.
  
  
  
  Between 1997 and 2009, 32 eligible children were enrolled in HS II and III with anaplastic astrocytoma (AA, n = 19), glioblastoma multiforme (GBM, n = 11), or other HGG (n = 2). Central pathology review was completed on 78% of patients. Patients with predominantly brainstem tumors were excluded. Patients were to be treated with single induction chemotherapy regimen C, comprising four cycles of vincristine, carboplatin, and temozolomide. Following induction, patients underwent marrow-ablative chemotherapy and autologous hematopoietic cell rescue. Irradiation was used for patients with residual tumor after consolidation or >6 years old or at the time of tumor progression.
  
  
  
  The 5-year event-free survival (EFS) and overall survival (OS) for all HGG patients were 25 ± 8% and 36 ± 9%, respectively. The EFS at 5 years for patients with AA and GBM were 24 ± 11% and 30 ± 16%, respectively (P = 0.65). The OS at 5 years for patients with AA and GBM was 34 ± 12% and 35 ± 16%, respectively (P = 0.83). Children <36 months old experienced improved 5-year EFS and OS of 44 ± 17% and 63 ± 17%, compared with children 36-71 months old (31 ± 13% and 38 ± 14%) and children >72 months old (0% and 13 ± 12%).
  
  
  
  Irradiation-avoiding treatment strategies should be evaluated further in young children with HGG given similar survival rates to older children receiving standard irradiation-containing therapies.
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Espinoza
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Kelley
authors.initials: K
authors.lastname: Haley
authors.affiliation: Department of pediatrics, University of Wisconsin, Madison, Wisconsin.
authors.forename: Neha
authors.initials: N
authors.lastname: Patel
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Girish
authors.initials: G
authors.lastname: Dhall
authors.affiliation: Department of pediatrics, New York University Medical Center, New York, New York.
authors.forename: Sharon
authors.initials: S
authors.lastname: Gardner
authors.affiliation: Department of pediatrics, New York University Medical Center, New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Allen
authors.affiliation: Children's Hospital of Oakland, Oakland, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Torkildson
authors.affiliation: DeVos Children's Hospital, Grand Rapids, Michigan.
authors.forename: Albert
authors.initials: A
authors.lastname: Cornelius
authors.affiliation: British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Rod
authors.initials: R
authors.lastname: Rassekh
authors.affiliation: Department of pediatrics, Loma Linda University Medical Center, Loma Linda, California.
authors.forename: Antranik
authors.initials: A
authors.lastname: Bedros
authors.affiliation: Phoenix Children's Hospital, Phoenix, Arizona.
authors.forename: Morris
authors.initials: M
authors.lastname: Etzl
authors.affiliation: Columbia Children's Hospital, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Garvin
authors.affiliation: Riley Children's Hospital, Indianapolis, Indiana.
authors.forename: Kamnesh
authors.initials: K
authors.lastname: Pradhan
authors.affiliation: Department of pediatrics, University of Otago, Christchurch, New Zealand.
authors.forename: Robin
authors.initials: R
authors.lastname: Corbett
authors.affiliation: Department of pediatrics, University of Otago, Christchurch, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Sullivan
authors.affiliation: Children's Hospital at Westmead, Sidney, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: McGowage
authors.affiliation: Promedica Children's Hospital of Toledo, Ohio.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Stein
authors.affiliation: Mercy Children's Hospital, Toledo, Ohio.
authors.forename: Rama
authors.initials: R
authors.lastname: Jasty
authors.affiliation: Department of pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Sands
authors.affiliation: USC Norris Comprehensive Cancer Center, Los Angeles, California.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Ji
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.affiliation: Department of pediatrics, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Finlay
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D060828:Induction Chemotherapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate
keywords: Head Start; gliomas; irradiation-avoiding strategies; pediatrics