Children <1 Year Show an Inferior Outcome When Treated According to the Traditional LGG Treatment Strategy: A Report From the German Multicenter Trial HIT-LGG 1996 for Children With Low Grade Glioma (LGG)

BackgroundChildren diagnosed with LGG at an age <1 year are reported to have an impaired prognosis in comparison to older patients. Analysis of this subgroup could reveal the necessity to develop risk-adapted treatment approaches. ProcedureChildren <1 year at diagnosis (n=66, median age 7.3 months, 33 female, none NFI) from the HIT-LGG 1996 cohort were analyzed for risk factors for EFS, PFS and OS. Several children suffered from diencephalic syndrome (DS, n=22) and primary dissemination (DLGG, n=9), 50 had a supratentorial midline (SML) location. Extent of resection was complete/subtotal in 12, partial in 15, biopsy in 27. Tumors were pilocytic astrocytoma WHO grade I (n=33), other WHO grade I (n=14), pilomyxoid astrocytomas WHO grade II (n=3), and neuroepithelial tumors WHO grade II (n=4). ResultsOne-year EFS was 34.8%. SML-localisation, minor extent of surgery, pilocytic astrocytoma, DLGG and DS were unfavorable predictive factors. No additional non-surgical therapy was applied in 24, 36 were treated with VCR/carboplatin chemotherapy, 6 with radiotherapy (5/6 brachytherapy). Ten-year-PFS-rate following non-surgical therapy was 16.7%; DS and DLGG were unfavorable factors. Ten-year-OS-rate was 72.8%, lower for children <6 months at diagnosis, with DS, or with DLGG. At last follow up in August 2011, vision in 31 living children was often severely impaired. ConclusionsChildren <1 year at diagnosis have a conspicuously impaired survival with current treatment approaches. Age <6 months, diencephalic syndrome and dissemination constitute risk factors for even lower PFS and OS. Treatment adaptations are needed to improve outcome and molecular genetics may explain tumor aggressiveness. Pediatr Blood Cancer 2014;61:457-463. (c) 2013 Wiley Periodicals, Inc.