High-Grade Gliomas in Children

Abstract

High-grade gliomas (HGGs) are malignant tumors and typically include glioblastoma multiforme and anaplastic astrocytoma subtypes. Brainstem gliomas and ependymomas are separate entities with respect to clinical presentation, treatment, prognosis, and outcome in comparison with supratentorial HGGs. In children, these tumors account for 3% to 7% of newly diagnosed brain tumors and 20% of all diagnoses of pediatric supratentorial brain tumors. These neoplasms are highly proliferative and mitotically active and of glial origin. This article reviews clinical, diagnostic, and pathologic features of HGG and current treatments and potential future therapies specific to pediatric patients with HGGs.

Pediatric Brain Tumors: Current Knowledge and Therapeutic Opportunities

“…Long-term side effects in survivors include cognitive deficits, cerebrovascular disease, and secondary tumors and can oftentimes reduce patients’ quality of life 24 . The role of chemotherapy in managing patients with pHGG is uncertain, and although evidence of efficacy is modest 25,26 , chemotherapeutic agents are often employed in the treatment of these patients 27 . While the results of a Children’s Oncology Group trial evaluating temozolomide for the treatment of pediatric patients with high grade glioma were disappointing 28 , the drug continues to be utilized in the treatment of these patients.…”

Factores pronósticos en pacientes con diagnóstico de glioma de alto grado manejados con radioterapia: experiencia en el Hospital Infantil de México Federico Gómez

“…La valoración adecuada debe realizarse al menos con secuencias potenciadas en T1 con y sin contraste como lesiones con componente sólido heterogéneo con bordes irregulares con reforzamiento, tras la aplicación del medio de contraste, y áreas de necrosis y calcificaciones de predominio central, así como en la reconstrucción potenciada en T2/FLAIR, para valorar en este último caso el edema. En caso de disponibilidad del recurso de la resonancia magnética multiparamétrica, se debe solicitar la resonancia funcional con espectroscopia, perfusión y difusión para un mejor diagnóstico de la actividad tumoral por imagen [6][7][8] . El tratamiento estándar inicial en el GAG es multimodal, y la cirugía extensa o resección total gruesa (RTG) es la piedra angular en cualquier edad.…”

“…El tratamiento estándar inicial en el GAG es multimodal, y la cirugía extensa o resección total gruesa (RTG) es la piedra angular en cualquier edad. En los niños mayores de tres años, se complementará con el manejo adyuvante de radioterapia convencional a dosis no mayores de 60 Gy y/o quimioterapia [8][9][10][11][12] . Hay que valorar la toxicidad tardía como las alteraciones neurocognitivas y neuroendocrinas y las vasculopatías al ofrecer los tratamientos 13 .…”

Prognostic Factors in Patients Diagnosed with High Grade Glioma Managed with Radiotherapy: Experience at the Federico Gómez Children's Hospital of Mexico

“…To assess edema, T2/FLAIR-weighted reconstruction is used. In case the resource of multi-parametric MRI is available, functional MRI should be performed with spectroscopy, perfusion, and diffusion for better diagnosis of tumor activity by imaging [6][7][8] . Initial standard treatment for HGG is multimodal, with extensive surgery or gross total resection being the cornerstone at any age.…”

“…Initial standard treatment for HGG is multimodal, with extensive surgery or gross total resection being the cornerstone at any age. In children older than three years, it will be supplemented with standard radiotherapy adjuvant management at doses not higher than 60 Gy and/or chemotherapy [8][9][10][11][12] . Late toxicity, such as neurocognitive or neuroendocrine alterations and vasculopathy, should be evaluated when the treatments are offered 13 .…”