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Child's Nervous System
Published in: Child's Nervous System 6/2017

01-06-2017 | Original Paper

Extent of surgical resection and adjuvant temozolomide improves survival in pediatric GBM: a single center experience

Authors: Subhash Gupta, Supriya Mallick, Rony Benson, K. P. Haresh, Pramod Kumar Julka, Goura Kishor Rath

Published in: Child's Nervous System | Issue 6/2017

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Abstract

Background

Pediatric glioblastoma (pGBM) is an uncommon entity. The importance of concurrent and adjuvant temozolomide is not known in this subset of patients.

Methods

We retrospectively analyzed our database between 2000 and 2015. All patients were treated with maximally safe surgical resection. This was followed by a uniform treatment schedule of post-operative radiation with concurrent daily temozolomide at 75 mg/m2. Radiation dose was 60 Gy in 30 fractions planned by 3-dimensional conformal radiotherapy. Concurrent and adjuvant temozolomide was used in all patients treated after 2007. Four weeks later, adjuvant temozolomide was started at 150 mg/m2, day 1 to 5 every 28 days and escalated to 200 mg/m2 from the second cycle onwards if well tolerated. Log-rank test was used to compare survival distribution. The data was analyzed using SPSS (version 16).

Results

Fifty-one patients were analyzed. Median age was 14 years (range: 5 to 21 years). Thirty-five males and 16 females were noted. Median symptom duration was 4 months. Twenty-eight patients underwent a gross total resection (GTR) while 17 underwent a subtotal resection; six patients underwent decompression. Thirty-three patients received concurrent chemotherapy while 27 received adjuvant chemotherapy. Median progression-free survival (PFS) was 15.1 months. One- and 3-year PFS was 54.4% and 3-year PFS was 24.6.7%. The median overall survival was 17.4 months. In univariate analysis survival was better for gross total resection (17.4 months vs. 11.5 months; p = 0.037), and significance maintained after multivariate analysis p = 0.026, HR 3.069, 95% CI 1.14–8.23. In univariate analysis, survival was better for patients receiving temozolomide but did not achieve significance. However, in multivariate analysis, use of temozolomide was associated with significantly improved survival p = 0.036, HR 3.315, 95% CI 1.07–10.19.

Conclusions

GTR improves survival significantly in pGBM. Adjuvant temozolomide may improve survival in pGBM.
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Metadata
Title
Extent of surgical resection and adjuvant temozolomide improves survival in pediatric GBM: a single center experience
Authors
Subhash Gupta
Supriya Mallick
Rony Benson
K. P. Haresh
Pramod Kumar Julka
Goura Kishor Rath
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 6/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-017-3381-6

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