13946
document
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 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 .
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Intervention_Physical
chemotherapy with or without radiotherapy
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Intervention_Physical
chemotherapy and radiotherapy
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Intervention_Pharmacological
lomustine , vincristine , and prednisone ( control regimen )
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Intervention_Pharmacological
the 8-drugs-in-1-day regimen ( experimental regimen )
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Outcome_Other
clinical and biologic features
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Outcome_Mortality
progression-free survival ( PFS ) rate
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Outcome_Mortality
overall survival ( OS ) rate
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Outcome_Mortality
PFS rate
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Outcome_Mortality
OS rate
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Outcome_Mortality
5-year PFS
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Outcome_Mortality
PFS
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Outcome_Mortality
OS
13959
Outcome_Mortality
survival advantage
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Participant_Age
children
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Participant_Condition
low-grade gliomas
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Participant_Condition
chemotherapy with or without radiotherapy
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Participant_Age
children
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Participant_Condition
chemotherapy
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Participant_Condition
radiotherapy
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Participant_Condition
high-grade glioma
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Participant_Condition
low-grade gliomas
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Participant_Condition
central pathologic review
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Participant_Sample-size
250
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Participant_Age
children
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Participant_Condition
high-grade gliomas
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Participant_Age
24 months
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Participant_Condition
intracranial lesions
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Participant_Age
younger
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Participant_Condition
primary spinal cord tumors
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Participant_Condition
low-grade glioma
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Participant_Sample-size
70
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Participant_Sample-size
42
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Participant_Sex
males
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Participant_Sample-size
28
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Participant_Sex
females
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Participant_Age
7.7 years
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Participant_Age
10.4 years