Advertisement

Journal of Neuro-Oncology

, Volume 72, Issue 2, pp 179–183 | Cite as

Primary dissemination of high-grade gliomas in children: experiences from four studies of the Pediatric Oncology and Hematology Society of the German Language Group (GPOH)

  • Martin Benesch
  • Sabine Wagner
  • Frank Berthold
  • Johannes E. A. Wolff
Clinical Study

Abstract

Purpose. Clinical data on central nervous system (CNS) dissemination of high-grade gliomas (HGG) at initial presentation in children are rare.

Patients and methods. We conducted a retrospective data analysis of all patients enrolled into four consecutive HGG protocols of the Pediatric Oncology and Hematology Society of the German Language Group (GPOH) to determine the incidence of primary CNS dissemination of HGG and to describe clinical characteristics and outcome of children with HGG who were diagnosed with CNS dissemination at initial presentation. 546 patients with newly diagnosed HGG (n=348) or diffuse intrinsic pontine gliomas (n=198) were enrolled in these four studies. Data concerning tumor dissemination are available from 324 patients.

Results. A total of 10 patients (3.1%) (anaplastic astrocytoma: n=3, glioblastoma multiforme: n=6, diffuse intrinsic pontine glioma: n=1) had primary tumor dissemination. Median age at diagnosis was 9.3 years (range: 0.3–21.3 years). The most frequent primary tumor sites were the cortex (n=4), followed by the ventricles (n=2), cerebellum (n=1), spinal cord (n=1), and pons (n=1). One patient had diffuse gliomatosis cerebri. Following surgery eight patients received local radiotherapy and eight additional chemotherapy. At a median follow-up of 10 months (range: 0.05–3 years) four patients are alive. None is disease-free. Median progression-free and overall survival was 0.8 years (95% CI 0.2–1.4) and 1.5 years (95% CI 0.67–2.29) for patients with primary tumor dissemination, respectively, with no statistically significant differences between the group with and the group without primary tumor dissemination.

Conclusions. Initial diagnostic evaluation should include complete CNS imaging as well as cerebrospinal fluid examination in all patients with HGG. As prognosis of children with HGG and primary CNS dissemination was not inferior to patients without dissemination in our population, these patients should be treated in the same way as patients without primary CNS dissemination.

Keywords

children high-grade gliomas primary dissemination prognosis treatment 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Pollack, IF 1994Brain tumors in childrenNew Engl J Med33115001507CrossRefPubMedGoogle Scholar
  2. 2.
    Heideman, RL, Kuttesch, J,Jr, Gajjar, AJ, Walter, AW, Jenkins, JJ, Li, Y, Sanford, RA, Kun, LE 1997Supratentorial malignant gliomas in childhoodCancer80497504CrossRefPubMedGoogle Scholar
  3. 3.
    Pendergrass, TW, Milstein, JM, Geyer, JR, Mulne, AF, Kosnik, EJ, Morris, JD, Heideman, RL, Ruymann, FB, Stuntz, JT, Bleyer, WA 1987Eight drugs in one day chemotherapy for brain tumors: experience in 107 children and rationale for preradiation chemotherapyJ Clin Oncol512211231PubMedGoogle Scholar
  4. 4.
    Marchese, MJ, Chang, CH 1990Malignant astrocytic gliomas in childrenCancer6527712778PubMedGoogle Scholar
  5. 5.
    Sposto, R, Ertel, IJ, Jenkin, RDT, Boesel, CP, Venes, JL, Ortega, JA, Evans, AE, Wara, W, Hammond, D 1989The effectiveness of chemotherapy for treatment of high grade astrocytoma in children: results of a randomized trial. A report from the Children’s Cancer Study GroupJ Neurooncol7165177CrossRefPubMedGoogle Scholar
  6. 6.
    Duffner, PK, Horowitz, ME, Krischer, JP, Friedman, HS, Burger, PC, Cohen, ME, Sanford, RA, Mulhern, RK, James, HE, Freeman, CR, Seidel, FG, Kun, LE 1993Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumorsNew Engl J Med32817251731CrossRefPubMedGoogle Scholar
  7. 7.
    Finlay, JL, Boyett, JM, Yates, AJ, Wisoff, JH, Milstein, JM, Geyer, JR, Bertolone, SJ, McGuire, P, Cherlow, JM, Tefft, M, Turski, PA, Wara, WM, Edwards, M, Sutton, LN, Berger, MS, Epstein, F, Ayers, G, Allen, JC, Packer, RJ 1995Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimenJ Clin Oncol13112123PubMedGoogle Scholar
  8. 8.
    Wolff, JEA, Mölenkamp, G, Westphal, S, Pietsch, T, Gnekow, A, Kortmann, RD, Kuehl, J 2000Oral trofosfamide and etoposide in pediatric patients with glioblastoma multiformeCancer8921312137CrossRefPubMedGoogle Scholar
  9. 9.
    Wolff, JEA, Westphal, S, Mölenkamp, G, Gnekow, A, Warmuth-Metz, M, Rating, D, Kuehl, J 2002Treatment of paediatric pontine glioma with oral trophosphamide and etoposideBr J Cancer87945949CrossRefPubMedGoogle Scholar
  10. 10.
    Wolff, JEA, Wagner, S, Sindichakis, M, Pietsch, T, Gnekow, A, Kortmann, RD, Sträter, R, Kuehl, J 2002Simultaneous radiochemotherapy in pediatric patients with high-grade glioma: a phase I studyAnticancer Res2235693572PubMedGoogle Scholar
  11. 11.
    Kleihues, PBurger, PCScheithauer, BW eds. 1993Histological Typing of Tumours of the Central Nervous SystemSpringer-VerlagBerlinGoogle Scholar
  12. 12.
    Kühl, J, Bode, U, Deinlein, F, Ottensmeier, H, Warmuth-Metz, M, Graf, N, Henze, G, Kaatsch, P, Kortmann, RD, Müller, H, Pietsch, T, Rating, D, Scheurlen, W, Sörensen, N, Wolff, JEA, Riehm, H 1999Cure of infants with medulloblastoma (M0/M1-stage) by postoperative chemotherapy onlyMed Pediatr Oncol33149(Abstract #O-107)Google Scholar
  13. 13.
    Awad, I, Bay, JW, Rogers, L 1986Leptomeningeal metastasis from supratentorial malignant gliomasNeurosurgery19247251PubMedGoogle Scholar
  14. 14.
    Vertosick, FT,Jr, Selker, RG 1990Brain stem and spinal metastases of supratentorial glioblastoma multiforme: a clinical seriesNeurosurgery27516521CrossRefPubMedGoogle Scholar
  15. 15.
    Arita, N, Taneda, M, Hayakawa, T 1994Leptomeningeal dissemination of malignant gliomas. Incidence, diagnosis and outcomeActa Neurochir (Wien)1268492CrossRefGoogle Scholar
  16. 16.
    Witham, TF, Fukui, MB, Meltzer, CC, Burns, R, Kondziolka, D, Bozik, ME 1999Survival of patients with high grade glioma treated with intrathecal thiotriethylenephosphoramide for ependymal or leptomeningeal gliomatosisCancer8613471353CrossRefPubMedGoogle Scholar
  17. 17.
    Grabb, PA, Albright, AL, Pang, D 1992Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in childrenNeurosurgery306471PubMedGoogle Scholar
  18. 18.
    Dropcho, EJ, Wisoff, JH, Walker, RW, Allen, JC 1987Supratentorial malignant gliomas in childhood: a review of fifty casesAnn Neurol22355364CrossRefPubMedGoogle Scholar
  19. 19.
    Packer, RJ, Siegel, KR, Sutton, LN, Litmann, P, Bruce, DA, Schut, L 1985Leptomeningeal dissemination of primary central nervous system tumors of childhoodAnn Neurol18217221CrossRefPubMedGoogle Scholar
  20. 20.
    Kramer, ED, Rafto, S, Packer, RJ, Zimmerman, RA 1991Comparison of myelography with CT follow-up versus gadolinium MRI for subarachnoid metastatic disease in childrenNeurology414650PubMedGoogle Scholar
  21. 21.
    Packer, RJ, Allen, J, Nielsen, S, Petito, C, Deck, M, Jereb, B 1983Brainstem glioma: clinical manifestations of meningeal gliomatosisAnn Neurol14177182CrossRefPubMedGoogle Scholar
  22. 22.
    Wolff, JEA, Gnekow, AK, Kortmann, RD, Pietsch, T, Urban, C, Graf, N, Kühl, J 2002Preradiation chemotherapy for pediatric patients with high-grade gliomaCancer94264271CrossRefPubMedGoogle Scholar
  23. 23.
    Stewart, LA 2002Glioma Meta-analysis Trialists (GMT) Group: Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trialsLancet35910111018CrossRefPubMedGoogle Scholar
  24. 24.
    Slavc, I, Schuller, E, Falger, J, Günes, M, Pillwein, K, Czech, T, Dietrich, W, Rössler, K, Dieckmann, K, Prayer, D, Hainfellner, J 2003Feasibility of long-term intraventricular therapy with mafosfamide (n=26) and etoposide (n=11): experience in 26 children with disseminated malignant brain tumorsJ Neurooncol64239247CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Martin Benesch
    • 1
  • Sabine Wagner
    • 2
  • Frank Berthold
    • 3
  • Johannes E. A. Wolff
    • 2
    • 4
  1. 1.Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescence MedicineMedical University of GrazAuenbruggerplatz 30Austria
  2. 2.Department of Pediatric Hematology/OncologySabine Wagner
  3. 3.Department of Pediatric Hematology/OncologyUniversity of KölnGermany
  4. 4.Department of Pediatric OncologyThe University of CalgaryAlbertaCanada

Personalised recommendations