Prognostic factors and therapeutic options of radiotherapy in pediatric brain stem gliomas.

Abstract

BACKGROUND:

A retrospective analysis was made to clarify the relationship between prognosis, radiation dose and survival of brain stem gliomas.

METHODS:

From 1983 to 1995, 22 children with brain stem tumors were treated by radiotherapy in the Veterans General Hospital-Taipei. Twelve patients had pathology proof and the remainder were diagnosed by computerized tomography and/or magnetic resonance imaging. Seven patients had postoperative radiotherapy. Fifteen patients had radiotherapy as primary management, five of whom had adjuvant chemotherapy. All patients received 4000-7060 cGy, either in conventional daily or hyperfractionated twice daily radiotherapy. Survival from date of diagnosis was calculated by the Kaplan-Meier method. Univariate analyses and multivariate analyses were calculated by the log rank test and the Cox proportional hazard model, respectively.

RESULTS:

Most patients showed improvement following treatment. The overall 2-year survival rate was 55.5% with a median survival of 27.1 months. Two-year survival for patients with primary management of operation and radiotherapy (n = 7), radiotherapy alone (n = 10) and radiotherapy with adjuvant chemotherapy (n = 5) were 66.7, 50 and 53.3%, respectively. In univariate analysis, the study revealed that the growth pattern of tumors and the simultaneous presence of cranial neuropathy and long tract sign were significant prognostic factors (P = 0.017 and 0.036). A trend of better outcome with radiation dose > 6600 cGy and the hyperfractionation scheme was also noted in our study (P = 0.0573 and 0.0615). However, only the hyperfractionation scheme was also noted in our study (P = 0.0573 and 0.0615). However, only the hyperfractionation scheme showed significance in multivariate analyses (P = 0.0355). Survival was not significantly affected by age, gender or method of diagnosis.

CONCLUSION:

Radiotherapy appears to be an effective treatment modality of brain stem tumors. Patients with both cranial neuropathy and long tract signs had a poorer outcome. Hyperfractionated radiotherapy may give better local control and lead to better survival.

• Authors: Y M Liu, C Y Shiau, T T Wong, L W Wang, L J Wu, K H Chi, K Y Chen, S H Yen
• Journal: Japanese journal of clinical oncology (Jpn J Clin Oncol) Vol. 28 Issue 8 Pg. 474-9 (Aug 1998) ISSN: 0368-2811 [Print] England
• PMID: 9769780 (Publication Type: Journal Article)

Topics

• Brain Neoplasms (mortality, radiotherapy)
• Brain Stem
• Child
• Female
• Glioma (mortality, radiotherapy)
• Humans
• Male
• Multivariate Analysis
• Prognosis
• Proportional Hazards Models
• Radiotherapy Dosage
• Retrospective Studies
• Survival Rate