Outcome of Therapies for Supratentorial Low-Grade Gliomas in Children

Outcome

Findings affecting prognosis

• Age of patient: Age at the time of initial surgery does not seem to be predictive for survival (23).  Some have found younger patients to have a better prognosis (6).
• Absence of neurological findings: Tumors that produce neurological deficits have a poorer prognosis than those that do not (7).
• Imaging and contrast enhancement: The absence of contrast uptake on MRI is associated with longer survival (4).  Lesions that cross the midline have a worse prognosis (4).

• Degree of resection: The extent of resection has been found to be a strong predictor for survival. Patients with total resection are expected to have a 93% PFS rate at 8 years as compared to 56% in those with <1.5 cm3 residual tumor and 45% in those with more than 1.5 cm3 residual tumor after initial surgery (23).

• Location of tumor: Patients with tumors in the cerebellum followed by tumors in the cerebral hemispheres seem to have better overall PFS rates than do those with tumors in the midline or within the hypothalamus and chiamism (23).
• Histology of tumor: Patients with JPAs and gangliogliomas have a PFS rate of 80% at 5 years as opposed to patients with non-JPA astrocytomas and other gliomas, where the 8-year PFS rates are 68% and 64%, respectively (23). The 5-year survival rate for fibrillary astrocytomas is 45%.

Grading of risk

• Risk for recurrence can be graded: Patients with no more than two unfavorable risk factors based on the first four points listed above have a life expectancy of nearly 8 years while those with three or more risk factors have a worse outome (7)