Chiasmal gliomas: results of irradiation management in 57 patients and review of literature

Bataini, J. P.; Delanian, S.; Ponvert, D.

doi:10.1016/0360-3016(91)90678-w

Cited by 88 publications

(57 citation statements)

References 21 publications

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“…2,33,34 For patients who have tumors that are not amenable to resection, the choice of therapy is more controversial. Although radiotherapy provides durable disease control with 5-year OS rates of 75-90% in patients with hypothalamic-optic pathway gliomas, 6,[35][36][37] concerns for the long-term neurocognitive and neuroendocrine sequelae of radiotherapy have led investigators to explore the use of chemotherapy, especially in younger patients. Furthermore, a recent study demonstrated that among children with subtotally resected low-grade gliomas, there was no statistically significant difference in OS between patients who received radiotherapy initially and patients who were observed.…”

Section: Outcomementioning

confidence: 99%

“…2 However, for patients with midline and other tumors for whom extensive resection is not possible, the most appropriate management remains undefined. [3][4][5] Although radiotherapy provides durable disease control in a significant percentage of such patients, 6,7 the neurocognitive and neuroendocrine sequelae associated with radiotherapy, especially in younger patients, have led many investigators to explore the use of chemotherapy. Agents that have been used include actinomycin D, 8 vincristine, 9 carmustine, 10 carboplatin, [11][12][13] and etoposide.…”

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confidence: 99%

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Outcome of children with centrally reviewed low‐grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high‐grade glioma study CCG‐945

Fouladi

Hunt

Pollack

et al. 2003

Cancer

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BACKGROUNDThe objectives of the current study were to determine the outcome of children who were treated with chemotherapy and radiotherapy on the Children's Cancer Group (CCG) high‐grade glioma protocol (CCG‐945) who were diagnosed with low‐grade gliomas on post hoc central pathologic review and to identify clinical and biologic features associated with prognosis.METHODSBetween 1985 and 1991, 250 children with institutionally classified high‐grade gliomas were enrolled on CCG‐945. Patients older than 24 months with intracranial lesions were assigned randomly to receive either lomustine, vincristine, and prednisone (control regimen) or the 8‐drugs‐in‐1‐day regimen (experimental regimen); younger patients and those with primary spinal cord tumors were assigned nonrandomly to the experimental regimen. Central independent review by 5 neuropathologists led to a reclassification of low‐grade glioma in 70 patients, who were the focus of the current study.RESULTSThe study involved 42 males and 28 females (median age, 7.7 years) with a median follow‐up of 10.4 years. At 5 years, the progression‐free survival (PFS) rate was 63% ± 6%, and the overall survival (OS) rate was 79% ± 5%, compared with a PFS rate of 19% ± 3% (P < 0.0001) and an OS rate of 22% ± 3% (P < 0.0001) in the remainder of the cohort. Significantly poorer 5‐year PFS was seen in children younger than 24 months, those with fibrillary astrocytoma, and those with posterior fossa tumors. Patients demonstrated a modest improvement in PFS but no improvement in OS compared with children with low‐grade gliomas who were treated with contemporary chemotherapy‐alone approaches.CONCLUSIONSThe current report calls attention to the importance of central pathologic review in large multiinstitutional trials of children with gliomas and suggests that aggressive front‐line combined chemoradiotherapy does not confer a survival advantage in this highly selected population of patients. Cancer 2003;98:1243–52. © 2003 American Cancer Society.DOI 10.1002/cncr.11637

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Section: Outcomementioning

confidence: 99%

mentioning

confidence: 99%

Outcome of children with centrally reviewed low‐grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high‐grade glioma study CCG‐945

Fouladi

Hunt

Pollack

et al. 2003

Cancer

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“…10,11,13,14,16 In this report, we identified the presence of an optic pathway glioma, but not neurofibromatosis, as a significant risk factor for subsequent stroke. We were unable to identify neurofibromatosis as a risk factor for stroke in our series, even though 13 patients with neurofibromatosis also were treated with radiation therapy (data not shown).…”

Section: Discussionmentioning

confidence: 68%

“…1,2 Strokes are believed to be more common among children with central nervous system (CNS) tumors. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, existing reports of stroke among children with CNS tumors do not include a control study population and therefore do not allow for the determination of the incidence of stroke nor identify risk factors for their occurrence.…”

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confidence: 99%

Nonperioperative strokes in children with central nervous system tumors

Bowers

Mulne

Reisch

et al. 2002

Cancer

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BACKGROUNDNonperioperative strokes are rare yet potentially devastating events for children with central nervous system (CNS) tumors. The incidence of and risk factors for nonperioperative strokes in children with CNS tumors is unknown.METHODSThe authors performed a retrospective review of children from their institution with CNS tumors. The incidence of stroke in the nonperioperative period and the influence of patient demographic factors, coexisting genetic diseases, tumor type, and treatment modality on the subsequent occurrence of a stroke were determined.RESULTSEight hundred seven consecutive patients from the authors' institution with CNS tumors were observed for a combined 3224 nonperioperative years. Thirteen patients (1.6%) had a nonperioperative stroke, for an incidence of 4.03 strokes/1000 years of nonperioperative patient follow‐up. Eight patients were males, and the median age at diagnosis of a CNS tumor was 4.8 years (range, 0.3–18.6 years). The median duration from diagnosis of a CNS tumor until the occurrence of stroke was 2.3 years (range, 0.3–15.8 years). Among numerous potential risk factors individually examined by chi‐square analysis, only treatment with radiation therapy was associated with the subsequent development of a stroke (chi‐square, P = 0.007). By logistic regression analysis, treatment with radiation therapy and a diagnosis of an optic pathway glioma were the only statistically significant variables associated with a stroke.CONCLUSIONSStrokes are much more common among children with CNS tumors. Children treated with radiation therapy and those with optic pathway gliomas have a higher association with the occurrence of a subsequent nonperioperative stroke. Because children with optic pathway gliomas may be at particularly high risk of stroke after radiation therapy, the desired beneficial therapeutic effects of irradiation must always be weighed against its potentially adverse effects, including stroke. Cancer 2002;94:1094–101. © 2002 American Cancer Society.DOI 10.1002/cncr.10353

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“…RT is highly effective for OPTs: 10-year PFS rates exceed 80% (25,31). Although OS at 10 years is unaffected by the initial therapeutic approach, PFS rates at 5 and 10 years are substantially higher after RT (26).…”

Section: Radiation Therapymentioning

confidence: 99%