Response of Pediatric Low Grade Gliomas to Chemotherapy

Abstract

Thirteen patients with low grade astrocytomas were treated with alkylating agent or platinum-based chemotherapy regimens. Eleven of these patients received chemotherapy as their initial postoperative treatment modality, and 2 others as treatment for progessive disease postradiation therapy. Responses were objectively determined using CT or MRI. One patient had a complete response (CR), 6 had partial responses (PR), and 3 others had stable disease (SD) as their best response. Clinical responses paralleled those determined objectively. Chemotherapy was well tolerated with the exception of ototoxic-ity in 4 patients treated with cisplatin. Despite good initial responses, 5 of 6 patients who received no further treatment postchemotherapy (4 PR, 1 SD) developed progressive disease 5–13 months after completing chemotherapy. The remaining 4 patients with objective responses or stable disease (1 CR, 2 PR, 1 SD), all received further postchemotherapy treatment with radiation therapy or surgery, and have not demonstrated disease progression. Our experience suggests that alkylator or platinum-based chemotherapy can successfully delay the growth of these locally infiltrative neoplasms, and should be considered in their primary management. Despite the experience of others, further therapy appears necessary in patients with residual CT or MRI abnormalities postchemotherapy.

Clinical and treatment factors determining long‐term outcomes for adult survivors of childhood low‐grade glioma: A population‐based study

“…13,17,18 The comparison of previous studies is often inconclusive; newly recognized pathological entities such as pilomyxoid astrocytoma and pleomorphic xanthoastrocytoma were not described in older studies, 10,11,19,20 some studies incorporated patients diagnosed before the widespread use of magnetic resonance imaging, 5 and others used series from referral centers, where patient bias exists. 21,22 The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database 5 and Childhood Cancer Survivor Study [23][24][25][26] have been valuable resources in the study of the long-term outcomes of pediatric cancers. Nevertheless, several shortcomings of the SEER database hamper the evaluation of pertinent issues related to PLGG outcomes, such as a lack of exact pathology subtypes for the early years and a lack of key background demographic information (eg, the NF1 status), 5 and the Childhood Cancer Survivor Study reports missing outcome data for up to 30% of the survivors of childhood central nervous system malignancies due to loss to followup or a refusal to participate.…”

Bilateral Optic Pathway Ganglioglioma: The Fifth Case in the Literature

“…Total resection of optic nerve tumors has a good prognosis, with 92% of cases surviving 15 years irrespective of neurofibromatosis status. However, regardless of their histologically benign features, chiasmatic-diencephalic gliomas have a worse prognosis [14]. Gangliogliomas are also benign and slow-growing tumors.…”

Low-grade gliomas in children: tumor volume response to radiation

“…Packer, et al, [19] have reported their response rate findings after using chemotherapy to treat low-grade gliomas, noting that 23 of 37 patients with low-grade glioma who were newly diagnosed as diencephalic and 12 of 23 patients with recurrent disease experienced a 50% or greater reduction in tumor volume. Gajjar, et al, [7] reported a response rate to chemotherapy of 57% in 14 children with progressive low-grade gliomas, although it is not known whether response to chemotherapy correlates with improved survival. Over the follow-up period for our patient group, 47% of the tumors responded to radiation, with 44% demonstrating a 50% or greater volume reduction over time.…”