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Anaplastic mixed gliomas and anaplastic oligodendroglioma in children: results from the CCG 945 experience

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Abstract

Purpose

To review interpathologist diagnosis variability and survival of children treated for either anaplastic mixed glioma (AMG) or anaplastic oligodendroglioma (AO) with surgery, irradiation and chemotherapy.

Patients and methods

Two hundred and fifty patients with an institutional diagnosis of malignant glioma were enrolled on Children’s Cancer Group CCG-945 between 1985 and 1991, and administered vincristine during involved field radiotherapy, then six cycles of prednisone, lomustine and, vincristine; or two cycles of “eight-drugs-in-one-day” (8-in-1) chemotherapy then involved-field radiotherapy followed by six cycles of 8-in-1 chemotherapy. Central review of institutional pathology was post hoc by five experienced neuropathologists.

Results

Twenty-six children had institutional diagnoses of AMG and four had AO. Complete resection and cerebral tumor location was associated with better overall survival (OS) in patients with institutional diagnoses of AMG. However, central review established that only nine of 26 children had AMG: either mixed oligoastrocytoma (MOA) or anaplastic mixed oligoastrocytoma (AOA) and only one had AO. Central review revealed five more patients with AMG, but none with AO. Institutional and CCG central review diagnoses of AMG or AO had poor Jaccard reliabilities of 0.29 and 0.25 respectively. Five-year EFS and OS for five children with centrally confirmed MOA was 50 ± 20%, with four centrally confirmed AOA was 37.5 ± 17%. After central review, small samples made tests for differences in survival between regimes impossible.

Conclusion

Diagnosis of these tumors is challenging, with only 35% of institutional diagnoses confirmed for AMG and 25% for AO, and survival among children with these tumors is poor, despite intensive therapy. This suggests reliable diagnostic markers and new therapeutic approaches are needed.

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Acknowledgements

The authors acknowledge the contribution of the late Lawrence Becker, MD to the pathology review in this study.

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Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Douglas J. Hyder

  2. Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

    Lillian Sung

  3. Department of Neurosurgery, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Ian F. Pollack

  4. Department of Pathology, Childrens Hospital Los Angeles, Los Angeles, CA, USA

    Floyd H. Gilles

  5. Division of Neuropathology, Department of Pathology, The Ohio State University, Columbus, OH, USA

    Allen J. Yates

  6. Department of Pathology, University of California, San Francisco, CA, USA

    Richard L. Davis

  7. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    James M. Boyett

  8. Department of Pediatrics, Childrens Hospital Los Angeles, Los Angeles, CA, USA

    Jonathan L. Finlay

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  1. Douglas J. Hyder
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  2. Lillian Sung
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  3. Ian F. Pollack
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  4. Floyd H. Gilles
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  5. Allen J. Yates
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  6. Richard L. Davis
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  7. James M. Boyett
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  8. Jonathan L. Finlay
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Correspondence to Douglas J. Hyder.

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Hyder, D.J., Sung, L., Pollack, I.F. et al. Anaplastic mixed gliomas and anaplastic oligodendroglioma in children: results from the CCG 945 experience. J Neurooncol 83, 1–8 (2007). https://doi.org/10.1007/s11060-006-9299-6

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  • DOI: https://doi.org/10.1007/s11060-006-9299-6

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