Metastatic Low‐Grade Gliomas in Children: 20 Years' Experience at St. Jude Children's Research Hospital

Abstract

Background Patients with low-grade gliomas (LGG), which are the most common childhood brain tumors, have excellent long-term survival. Dissemination of LGG is rare. Robust data on the incidence, presentation, patterns of dissemination, disease behavior, outcome, and best-management approaches do not exist. We describe 20 years of follow-up of children with metastatic LGG. Procedure Data collected during the period 1990–2010 were retrospectively reviewed for the following inclusion criteria: diagnosis of metastatic LGG, age younger than 21 years at initial diagnosis, and magnetic resonance imaging of the brain and/or spine at diagnosis and/or follow-up. Patient demographics, pathology, treatment modalities, and outcome were reviewed. Results Of 599 patients with LGG, 38 (6%) had metastatic disease at either diagnosis or follow-up. Most tumors (87%) were located in the brain, and half of the patients had metastatic disease at presentation. The most common diagnosis was pilocytic astrocytoma (55%). Chemotherapy was the most common initial treatment modality. Median survival of the group was 6.2 years (range, 0.1–16.9 years). Fifteen (40%) patients died at a median of 6 years from diagnosis (range, 0.8–15 years). Overall survival at 5, 10, and 15 years was 80.7 ± 6.6%, 63.0 ± 10.2%, and 50.9 ±16.0%, respectively. Conclusion This study describes the longest follow-up of children with metastatic LGG. LGG is underestimated and entails major morbidity and mortality. Prospective studies are needed to learn the true incidence, study the biology, and determine the best approaches to diagnosis, treatment, and follow-up.

Treatment burden and long‐term health deficits of patients with low‐grade gliomas or glioneuronal tumors diagnosed during the first year of life

“…An inability to achieve GTR of the tumor upfront, diencephalic syndrome, and possibly an HT/OP tumor location were associated with inferior PFS in our cohort; this is similar to observations of pediatric LGGs over the entire age spectrum . In agreement with previous studies, the proportion of infants with metastasis in our cohort was higher than that in pediatric LGG, but unlike in older patients, metastasis in infant LGG did not affect survival …”

Mortality in children with low‐grade glioma or glioneuronal tumors: A single‐institution study

“…Metastatic imaging work‐ups were available for 59 (68%) patients at diagnosis, seven of who had evidence of dissemination. This contrasts with a finding of 19 patients with metastatic disease at diagnosis in a larger cohort of 599 patients with LGG, alive or dead, reported from our institution by Chamdine et al . All patients had at least one imaging examination (either computed tomography or MRI) to investigate for dissemination.…”

Carboplatin and vincristine neurotoxicity in the treatment of pediatric low‐grade gliomas

“…The median age at diagnosis in our cohort was 4.0 years, which is similar to what has been reported in previous studies . Our study included more females (59%) whereas other studies have reported a male predominance in LGGs .…”

“…The median age at diagnosis in our cohort was 4.0 years, which is similar to what has been reported in previous studies. 14 Our study included more females (59%) whereas other studies have reported a male predominance in LGGs. 7 This might be explained by the fact that patients with optic pathway glioma are more often female than male and 86% of our cohort had optic pathway glioma.…”