Outcome of Therapies for High-Grade Gliomas in Children

Outcome After Surgery

• Morbidity varies with location and extent of resection: Surgical morbidity for children with supratentorial HGGs is dependent on tumor location, presenting symptoms, and extent of location. That is, aggressive resections in eloquent cortex are more likely to result in neurological deficit and disability than a biopsy of a lesion in a less critical area. The mortality rate is very low, commonly quoted at less than 1% (30).
• Survival varies with extent of resection: The extent of resection does seem to improve survival (37). Specific to neurosurgical intervention, however, even aggressive surgery alone is not curative for HGGs and does not serve as a monotherapeutic option (37).

Outcome After Nonsurgical Treatments

• Chemotherapy proven to increase survival: As mentioned above, although the extent of surgical resection may provide some benefit in survival, it is not the defining factor in outcome. Radiation alone for HGGs has not definitely been shown to affect survival but may be of benefit (23, 24). Chemotherapy has been shown to increase the 5-year survival rate from 18% with radiation alone to 46%. These outcomes, however, are after surgery (17, 18).

Outcome After Multimodal Therapies

• No dramatic advances for 30 years: Overall outcomes for children with HGGs are poor, despite surgery, radiation, and chemotherapy. Survival at 2 years for HGGs is 10–30% (4). Specific to GBM in children, 5-year survival rates range from 5–15% (17, 30, 38). AA 5-year survival rates are slightly better at 20–40% (17, 38). These statistics have remained generally unchanged for almost 30 years.