Loss of efficacy of subsequent nonsurgical therapy after primary treatment failure in pediatric low-grade glioma patients-Report from the German SIOP-LGG 2004 cohort.
Adolescent
Brain Neoplasms
/ pathology
Chemotherapy, Adjuvant
Child
Child, Preschool
Disease Progression
Female
Germany
/ epidemiology
Glioma
/ pathology
Humans
Infant
Internationality
Male
Neoplasm Grading
Neurofibromatosis 1
/ epidemiology
Neurosurgical Procedures
Platinum
/ therapeutic use
Progression-Free Survival
Radiotherapy, Adjuvant
Treatment Failure
Vinblastine
/ therapeutic use
chemotherapy
pediatric low-grade glioma
progression
radiotherapy
surgery
Journal
International journal of cancer
ISSN: 1097-0215
Titre abrégé: Int J Cancer
Pays: United States
ID NLM: 0042124
Informations de publication
Date de publication:
15 12 2020
15 12 2020
Historique:
received:
29
04
2020
revised:
02
06
2020
accepted:
10
06
2020
pubmed:
25
6
2020
medline:
17
4
2021
entrez:
25
6
2020
Statut:
ppublish
Résumé
First-line treatment of pediatric low-grade glioma using surgery, radio- or chemotherapy fails in a relevant proportion of patients. We analyzed efficacy of subsequent surgical and nonsurgical therapies of the German cohort of the SIOP-LGG 2004 study (2004-2012, 1558 registered patients; median age at diagnosis 7.6 years, median observation time 9.2 years, overall survival 98%/96% at 5/10 years, 15% neurofibromatosis type 1 [NF1]). During follow-up, 1078/1558 patients remained observed without (n = 217), with 1 (n = 707), 2 (n = 124) or 3 to 6 (n = 30) tumor volume reductions; 480/1558 had 1 (n = 332), 2 (n = 80), 3 or more (n = 68) nonsurgical treatment-lines, accompanied by up to 4 tumor-reductive surgeries in 215/480; 265/480 patients never underwent any neurosurgical tumor volume reduction (163/265 optic pathway glioma). Patients with progressing tumors after first-line adjuvant treatment were at increased risk of suffering further progressions. Risk factors were young age (<1 year) at start of treatment, tumor dissemination or progression within 18 months after start of chemotherapy. Progression-free survival rates declined with subsequent treatment-lines, yet remaining higher for patients with NF1. In non-NF1-associated tumors, vinblastine monotherapy vs platinum-based chemotherapy was noticeably less effective when used as second-line treatment. Yet, for the entire cohort, results did not favor a certain sequence of specific treatment options. Rather, all can be aligned as a portfolio of choices which need careful balancing of risks and benefits. Future molecular data may predict long-term tumor biology.
Substances chimiques
Platinum
49DFR088MY
Vinblastine
5V9KLZ54CY
Banques de données
ClinicalTrials.gov
['NCT00276640']
EudraCT
['2005‐005377‐29']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3471-3489Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2020 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.
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