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

BACKGROUND The 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...

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Bibliographic Details
Published in:Cancer 2003-09, Vol.98 (6), p.1243-1252
Main Authors: Fouladi, Maryam, Hunt, Daniel L., Pollack, Ian F., Dueckers, Gregor, Burger, Peter C., Becker, Laurence E., Yates, Allen J., Gilles, Floyd H., Davis, Richard L., Boyett, James M., Finlay, Jonathan L.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Antineoplastic agents
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Biological and medical sciences
Brain Neoplasms - radiotherapy
Brain Neoplasms - therapy
brain tumors
Child
Child, Preschool
Combined Modality Therapy
Combined treatments (chemotherapy of immunotherapy associated with an other treatment)
Female
Follow-Up Studies
Glioma - drug therapy
Glioma - pathology
Glioma - radiotherapy
Glioma - therapy
high‐grade glioma
Humans
Infant
Infant, Newborn
Lomustine - administration & dosage
low‐grade glioma
Male
Medical sciences
pediatrics
Pharmacology. Drug treatments
Prednisolone - administration & dosage
Prognosis
Treatment Outcome
Vincristine - administration & dosage
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Summary:BACKGROUND The 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. METHODS Between 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. RESULTS The 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. CONCLUSIONS The 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 This 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.
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.11637