Stereotactic radiotherapy for localized low-grade gliomas in children: final results of a prospective trial

Marcus, K. J.; Goumnerova, Liliana; Billett, Amy L.; Lavally, Beverly; Scott, Rebecca J.; Bishop, Karyn L.; Xu, Ran; Kieran, Mark W.; Kooy, H.M.; Pomeroy, SL; Tarbell, Nancy J.

doi:10.1016/s0360-3016(03)00997-0

Cited by 32 publications

(40 citation statements)

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“…Studies summarizing outcome of low grade glioma patients receiving adjuvant therapy in other locations report 12-78% 5-year EFS following chemotherapy and 63-87% 3-and 5-year EFS, respectively, following radiotherapy [25][26][27]. Tumors included in these studies involve the optic pathway/hypothalamus in most cases.…”

Section: Discussionmentioning

confidence: 99%

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Fried¹,

Hawkins²,

Scheinemann³

et al. 2011

Pediatric Blood & Cancer

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BackgroundPediatric brainstem tumors (BST) comprise a heterogeneous group of entities. Data regarding treatment options and outcome of BST, specifically brainstem low grade tumors (BSLGT) are limited. In order to better define risk groups and evaluate treatment options for pediatric BST, we performed a comprehensive analysis of all BST patients treated in our hospital during the MRI era.ProceduresWe retrospectively analyzed clinical, imaging, and pathology data at presentation, treatment, and outcome of all BST patients followed at the Hospital for Sick Children in Toronto over the last 25 years.ResultsOf 1,801 children with brain tumors, 223 (12%) had a brainstem primary location. Tumors without pontine involvement were BSLGT in 98.3%, whereas 75% of tumors involving the pons were high grade (P = 0.0001). Patients with BSLGT had 5‐year progression‐free survival (PFS) and overall survival (OS) of 57 ± 3% and 89 ± 5%, respectively. Upfront observation of tumor residual conferred no survival disadvantage with 5‐year PFS and OS of 57 ± 5% and 93 ± 3%, respectively. In the group of patients requiring further treatment, 5‐year PFS and OS were comparable between chemotherapy and radiotherapy with 53 ± 12% and 93 ± 4% and 66 ± 11% and 83 ± 6%, respectively (P = 0.26 and 0.3, respectively).ConclusionBST without pontine involvement are almost invariably BSLGT. Children with BSLGT have an excellent outcome even with careful initial observation. No clear benefit was observed for radiotherapy over chemotherapy when adjuvant treatment was needed. A conservative approach may be warranted for children with non‐pontine brainstem lesions. Pediatr Blood Cancer 2012; 58: 556–560. © 2011 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Fried¹,

Hawkins²,

Scheinemann³

et al. 2011

Pediatric Blood & Cancer

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“…One study demonstrated a 5-year OS of 97.7% and 8-year OS of 82% for children treated with stereotactic radiation therapy after evidence of recurrence or progression on chemotherapy or just after surgery alone. 107 To date, the role of radiation in the treatment of low-grade gliomas has not been established and further studies are indicated.…”

Section: Radiationmentioning

confidence: 99%

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

2009

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Summary:Pediatric CNS tumors are the most common solid tumors of childhood and the second most common cancer after hematological malignancies accounting for approximate 20 to 25% of all primary pediatric tumors. With over 3,000 new cases per year in the United States, childhood CNS tumors are the leading cause of death related to cancer in this population. The prognosis for these patients has improved over the last few decades, but current therapies continue to carry a high risk of significant side effects, especially for the very young. Currently a combination of surgery, radiation, and chemotherapy is often used in children greater than 3 years of age. This article will outline current and future therapeutic strategies for the most common pediatric CNS tumors, including primitive neuroectodermal tumors such as medulloblastoma, as well as astrocytomas and ependymomas.

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“…18 Stereotactic conformal radiotherapy has been associated with a 79% 5-year survival rate without the cognitive or endocrine disturbances associated with traditional external-beam radiation therapy. 11,51,65 Proton beam therapy is an attractive option for radiation therapy, as it is able to provide high doses of radiation to the lesion with sharp fall-off of energy within millimeters of the treatment area. In small series, it has been found to be well tolerated; however, it is not widely available to patients and has not proven to be superior to standard techniques.…”

Section: Radiotherapy For Opgsmentioning

confidence: 99%

Optic pathway gliomas: a review

Binning

Liu

Kestle

et al. 2007

FOC

170

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✓Optic pathway gliomas represent approximately 3–5% of childhood intracranial tumors. They usually occur in children during the first decade of life and are seen in 11–30% of patients with neurofibromatosis Type 1 (NF1). Although these tumors are typically low-grade gliomas, the clinical course and natural history are highly variable, making treatment paradigms difficult. Overall, however, they are often indolent tumors that can be observed over time for progression without initial treatment, especially in patients with NF1. Chemotherapy is the first-line treatment for progressive tumors, and radiation therapy is reserved for patients with progressive disease who are older than 5–7 years. Surgery is reserved for large tumors causing mass effect or hydrocephalus and tumors confined to the orbit or unilateral optic nerve.

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Stereotactic radiotherapy for localized low-grade gliomas in children: final results of a prospective trial

Cited by 32 publications

References 0 publications

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

Optic pathway gliomas: a review

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