Multimodality therapy of pediatric supratentorial high-grade astrocytic tumor

High-grade supratentorial astrocytic tumor comprise 10% of all childhood tumors of the central nervous system (CNS). High-grade gliomas have a poor prognosis despite the use of multimodality therapy including surgery, radiation therapy (RT), and chemotherapy. RT has been shown to prolong survival time, and several clinical trials have found adjuvant chemotherapy to be of benefit. However, long-term survival remains poor. There are few reports on outcomes in patients with pediatric malignant gliomas, therefore, we examined the outcomes of children with these tumors at our institution. From January 1995 to April 2010, 10 patients (5 females and 5 males) underwent surgery for high-grade supratentorial astrocytic tumor. The mean age was 10.7 years (range, 3 to 15 years). All tumors were located in supratentorial area. Histological diagnosis was obtained from all of the patients, and included anaplastic astrocytoma (AA) (7 cases) and glioblastoma (GBM) (3 cases). At our institution, neurosurgeons, pediatricians, pathologists, and radiologists performed multidisciplinary treatments for pediatric brain tumor. The 10 patients with high-grade gliomas underwent gross total resection (n=3), subtotal resection (n=6), or biopsy only (n=1). Radiation therapy was performed in 9 cases, with local external beam in 6 cases, brachytherapy in 1 case, γ-knife in 1 case, and boron neutron capture therapy (BNCT) in 1 case. Combination chemotherapy was administered to 9 patients of high grade glioma as follows: ranimustine (MCNU), carboplatin (CBDCA), and interferon (IFN)-β (MIC) in 3 cases; procarbazine, nimustine (ACNU), and vincristine (PAV) in 3 cases; ifosfamide, CBDCA, VP-16/vincristine, VP-16, cisplatin, cyclophosphamide (ICE/VCEC) in 1 case, and temozolomied (TMZ) in 2 cases. The median overall survival for all patients was 2.1 years, and the median progression free survival for all patients was 1.5 years. The results of this review of 10 children suggest that multidisciplinary treatment including neurosurgery produces a favorable outcome for non-brainstem, pediatric malignant gliomas. (author)