Juan C Espinoza1, Kelley Haley1, Neha Patel2, Girish Dhall1, Sharon Gardner3, Jeffrey Allen3, Joseph Torkildson4, Albert Cornelius5, Rod Rassekh6, Antranik Bedros7, Morris Etzl8, James Garvin9, Kamnesh Pradhan10, Robin Corbett11, Michael Sullivan11, Geoffrey McGowage12, Dagmar Stein13, Rama Jasty14, Stephen A Sands15, Lingyun Ji16, Richard Sposto1, Jonathan L Finlay17. 1. Children's Hospital Los Angeles, Los Angeles, California. 2. Department of pediatrics, University of Wisconsin, Madison, Wisconsin. 3. Department of pediatrics, New York University Medical Center, New York, New York. 4. Children's Hospital of Oakland, Oakland, California. 5. DeVos Children's Hospital, Grand Rapids, Michigan. 6. British Columbia Children's Hospital, Vancouver, British Columbia, Canada. 7. Department of pediatrics, Loma Linda University Medical Center, Loma Linda, California. 8. Phoenix Children's Hospital, Phoenix, Arizona. 9. Columbia Children's Hospital, New York, New York. 10. Riley Children's Hospital, Indianapolis, Indiana. 11. Department of pediatrics, University of Otago, Christchurch, New Zealand. 12. Children's Hospital at Westmead, Sidney, Australia. 13. Promedica Children's Hospital of Toledo, Ohio. 14. Mercy Children's Hospital, Toledo, Ohio. 15. Department of pediatrics, Columbia University Medical Center, New York, New York. 16. USC Norris Comprehensive Cancer Center, Los Angeles, California. 17. Department of pediatrics, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Abstract
PURPOSE: To report the final analysis of survival outcomes for children with newly diagnosed high-grade glioma (HGG) treated on the "Head Start" (HS) II and III protocols with chemotherapy and intent to avoid irradiation in children <6 years old. PATIENTS AND METHODS: Between 1997 and 2009, 32 eligible children were enrolled in HS II and III with anaplastic astrocytoma (AA, n = 19), glioblastoma multiforme (GBM, n = 11), or other HGG (n = 2). Central pathology review was completed on 78% of patients. Patients with predominantly brainstem tumors were excluded. Patients were to be treated with single induction chemotherapy regimen C, comprising four cycles of vincristine, carboplatin, and temozolomide. Following induction, patients underwent marrow-ablative chemotherapy and autologous hematopoietic cell rescue. Irradiation was used for patients with residual tumor after consolidation or >6 years old or at the time of tumor progression. RESULTS: The 5-year event-free survival (EFS) and overall survival (OS) for all HGG patients were 25 ± 8% and 36 ± 9%, respectively. The EFS at 5 years for patients with AA and GBM were 24 ± 11% and 30 ± 16%, respectively (P = 0.65). The OS at 5 years for patients with AA and GBM was 34 ± 12% and 35 ± 16%, respectively (P = 0.83). Children <36 months old experienced improved 5-year EFS and OS of 44 ± 17% and 63 ± 17%, compared with children 36-71 months old (31 ± 13% and 38 ± 14%) and children >72 months old (0% and 13 ± 12%). CONCLUSIONS: Irradiation-avoiding treatment strategies should be evaluated further in young children with HGG given similar survival rates to older children receiving standard irradiation-containing therapies.
PURPOSE: To report the final analysis of survival outcomes for children with newly diagnosed high-grade glioma (HGG) treated on the "Head Start" (HS) II and III protocols with chemotherapy and intent to avoid irradiation in children <6 years old. PATIENTS AND METHODS: Between 1997 and 2009, 32 eligible children were enrolled in HS II and III with anaplastic astrocytoma (AA, n = 19), glioblastoma multiforme (GBM, n = 11), or other HGG (n = 2). Central pathology review was completed on 78% of patients. Patients with predominantly brainstem tumors were excluded. Patients were to be treated with single induction chemotherapy regimen C, comprising four cycles of vincristine, carboplatin, and temozolomide. Following induction, patients underwent marrow-ablative chemotherapy and autologous hematopoietic cell rescue. Irradiation was used for patients with residual tumor after consolidation or >6 years old or at the time of tumor progression. RESULTS: The 5-year event-free survival (EFS) and overall survival (OS) for all HGG patients were 25 ± 8% and 36 ± 9%, respectively. The EFS at 5 years for patients with AA and GBM were 24 ± 11% and 30 ± 16%, respectively (P = 0.65). The OS at 5 years for patients with AA and GBM was 34 ± 12% and 35 ± 16%, respectively (P = 0.83). Children <36 months old experienced improved 5-year EFS and OS of 44 ± 17% and 63 ± 17%, compared with children 36-71 months old (31 ± 13% and 38 ± 14%) and children >72 months old (0% and 13 ± 12%). CONCLUSIONS: Irradiation-avoiding treatment strategies should be evaluated further in young children with HGG given similar survival rates to older children receiving standard irradiation-containing therapies.
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