Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children

Hirsch, J F; Rose, C. Sainte; Pierre-Kahn, Alain; Pfister, A; Hoppe-Hirsch, Elizabeth

doi:10.3171/jns.1989.70.4.0568

Cited by 164 publications

(88 citation statements)

References 12 publications

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“…The demonstration of a survival advantage to radical resection should prompt neurosurgeons to approach all malignant pediatric astrocytomas with the same aggressive attitude and operative techniques as they would use for benign, low-grade astrocytomas of childhood. [21,31] …”

Section: Discussionmentioning

confidence: 99%

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Wisoff

Boyett²,

Berger³

et al. 1998

FOC

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Object One hundred seventy-two children with high-grade astrocytomas were treated by members of the Children's Cancer Group in a prospective randomized trial designed to evaluate the role of two chemotherapy regimens. Seventy-six percent of the patients (131 children) in whom a diagnosis of either anaplastic astrocytoma or glioblastoma multiforme was confirmed by central pathological review are the subject of this report. Methods Patients were stratified according to the extent of tumor resection (biopsy [< 10%], partial resection [10-50%], subtotal resection [51-90%], near-total resection [> 90%], and total resection) as determined by surgical observation and postoperative computerized tomography scanning. Information on contemporary neurosurgical management was obtained from the patient's operative records and standardized neurosurgical report forms. The vast majority of tumors were supratentorial: 63% (83 tumors) in the superficial cerebral hemisphere, 28% (37 tumors) in the deep or midline cerebrum, and only 8% (11 tumors) in the posterior fossa. A significant association was detected between the primary tumor site and the extent of resection (p < 0.0001). A radical resection (> 90%) was performed in 37% of the children: 49% of the tumors in the superficial hematoma and 45% of tumors in the posterior fossa compared with 8% of midline tumors. Tumor location could also be used to predict the need for both temporary and permanent cerebrospinal fluid (CSF) diversion. Half of the deep tumors and 8% of the hemispheric astrocytomas ultimately required a permanent CSF shunt. Improvement in preoperative neurological deficits and level of consciousness was seen in 36% and 34% of the children, respectively. New or increased deficits were present in 14% of the children, with 6% experiencing a diminished sensorium after surgery. Postoperative nonneurological complications were rare, infection, embolization, and CFS fistula each occurring in 1.7% of the children. Univariate and multivariate analyses demonstrated that radical tumor resection (> 90%) was the only therapeutic variable that significantly improved progression-free survival (PFS) rates. For all patients with malignant astrocytomas, the distributions of PFS rates were significantly different (p = 0.006) following radical resection compared with less extensive (¾ 90%) resection. The 5-year PFS rates were 35 ± 7% and 17 ± 4%, respectively. The differences in the distribution of PFS rate were significantly different for the subsets of patients with anaplastic astrocytoma (p = 0.055) and glioblastoma multiforme (p = 0.046). The 5-year PFS rates for anaplastic astrocytoma were 44 ± 11% and 22 ± 6% for cases in which the tumor was radically resected and less than radically resected, respectively; whereas the 5-year PFS rates for glioblastoma multiforme were 26 ± 9% and 4 ± 3% for cases in which the tumor was radically resected and less than radically resected, respectively. Conclusions The demonstration of a survival advantage provided by radical resection should prompt neurosurgeons to treat malignant pediatric astrocytomas with aggressive surgical resection prior to initiation of radiotherapy or adjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Wisoff

Boyett²,

Berger³

et al. 1998

FOC

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“…[7] For gliomas that arise in other regions of the brain, such as the chiasm, hypothalamus, thalamus, or cerebral cortex, the benefit of aggressive surgery is less well documented. [2,7,9,10,27] Although extensive resections are often possible and may result in at least transient disease control, they may also result in significant neurological and cognitive sequelae. [27] For those patients in whom total or near-total resection cannot be safely performed, radiation therapy has often been recommended.…”

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confidence: 99%

Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

Packer¹,

Ater²,

Allen³

et al. 1997

FOC

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The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of chemotherapy for young children, but little information concerning the long-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months-16 years) who had newly diagnosed, progressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 30 months from diagnosis, with 31 patients followed for more than 3 years. Fifty-eight children had diencephalic tumors, 12 had brainstem gliomas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) of 78 patients showed an objective response to treatment. Progression-free survival rates were 75 ± 6% at 2 years and 68 ± 7% at 3 years. There was no statistical difference in progression-free survival rates between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 ± 11% vs. 75 ± 6%, respectively). The histological subtype of the tumor, its location, and its maximum response to chemotherapy did not have an impact on the duration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3-year progression-free survival rate of 74 ± 7% compared with a rate of 39 ± 21% in older children (p < 0.01). Treatment with carboplatin and vincristine is effective, especially in younger children, in controlling newly diagnosed progressive low-grade gliomas.Key Words * glioma * chiasmatic glioma * low-grade glioma * brainstem tumor * chemotherapy * children Gliomas comprise more than 50% of all childhood brain tumors and approximately 80% of these lesions

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“…This being said, among children, seizures as a presenting symptom of brain tumour are most commonly complex or simple partial, versus generalized, with complex partial seizures generally accounting for from 50% to as high as 85% of all new-onset seizures [32,63,69,86,[115][116][117]. The lone series in which this was not true was that reported by Hirsch et al, in which complex and simple partial seizures together only accounted for half of all cases [118]. The percentages generally reported for children and adolescents are somewhat different than for adults, in whom tumour-associated seizures tend to be more evenly distributed across the four most typical seizure types [58].…”

Section: How Seizures Presentmentioning

confidence: 89%

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

Ranger¹,

Diosy²

2015

Molecular Considerations and Evolving Surgical Management Issues in the Treatment of Patients With a Brain Tumor

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Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children

Cited by 164 publications

References 12 publications

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

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