Complete Resection of High-Grade Gliomas Yields Better Survival in Children, Especially Girls
For children with aggressive brain cancers called high-grade gliomas, the chances of survival are improved when surgery is successful in eliminating all visible cancer, according to a report published by McCrea et al in Neurosurgery.
In addition to showing better survival with gross total resection for children with high-grade gliomas, the results suggest that this survival benefit is greater in girls compared to boys with this brain cancer. The study provides “compelling evidence that gross total resection is even more critical in female patients,” wrote Jeffrey P. Greenfield, MD, PhD, Associate Professor of Neurological Surgery at Weill Cornell Medical College, and colleagues.
Study Findings
High-grade pediatric gliomas are serious but uncommon brain tumors, occurring at a rate of less than 1 in 100,000 children and adolescents.
The researchers analyzed 97 children, median age 11 years, treated for high-grade gliomas between 1988 and 2010.
Reflecting the poor prognosis of these aggressive brain cancers, the children had high rates of recurrent or progressive cancer and a substantial mortality rate. The 2-year survival rate was 45%, while the rate of survival with no cancer progression was 25%.
Gross total resection—complete removal of all visible tumor tissue—was achieved for one-third of the children. Children with gross total resection had significantly better overall survival—median 3.4 years, compared to 1.6 years for those with partial (subtotal) resection.
In addition, the improvement in survival with complete resection differed by sex. Median overall survival was 8.1 years for girls, vs 2.4 years for boys with gross total resection. When gross total resection wasn't achieved, median survival was 1.4 years for both boys and girls.
Survival was also affected by the tumor's location in the brain, but was similar for patients with different cellular types of high-grade glioma. Gross total resection improved the chances of survival without recurrent or progressive cancer only in children with glioblastoma multiforme.
Future Research Emphasis
High-grade gliomas make up about 30% of brain tumors in adults, compared with 8% to 12% in children. Neurosurgeons previously believed that the factors affecting outcomes were similar for all age groups. But recent genetic studies have shown clear distinctions between pediatric and adult high-grade gliomas, highlighting the need for research to see how differences in glioma-related mutations affect the clinical behavior of the disease.
While gross total resection is already the standard of care, the study reemphasizes the importance of removing all visible tumor to improve survival for children with high-grade gliomas. “In addition,” the researchers wrote, “we found that the benefit of a gross total resection appears to be much greater for female patients than for male patients.”
Based on this finding, “it may be even more critical to achieve gross total resection in female patients,” in addition to possible “differences between the biology of tumors in male and female patients,” the researchers added.
Emphasis is currently directed toward studies exploring the impact of different genetic and molecular subtypes, particularly with respect to understanding the potential impact of sex-chromosome gene-expression patterns—differences that may help clarify this discrepancy in survival rates for boys and girls with high-grade gliomas.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
