Clinical and treatment factors determining long-term outcomes for adult survivors of childhood low-grade glioma: A population-based study

Rahul Krishnatry, Nataliya Zhukova, Ana S. Guerreiro Stucklin, Jason D. Pole, Matthew Mistry, Iris Fried, Vijay Ramaswamy, Ute Bartels, Annie Huang, Normand Laperriere, Peter Dirks, Paul C. Nathan, Mark Greenberg, David Malkin, Cynthia Hawkins, Pratiti Bandopadhayay, Mark W. Kieran, Peter E. Manley, Eric Bouffet, Uri Tabori

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Abstract

BACKGROUND The determinants of outcomes for adult survivors of pediatric low-grade glioma (PLGG) are largely unknown. METHODS This study collected population-based follow-up information for all PLGG patients diagnosed in Ontario, Canada from 1985 to 2012 (n = 1202) and determined factors affecting survival. The impact of upfront radiation treatment on overall survival (OS) was determined for a cohort of Ontario patients and an independent reference cohort from the Surveillance, Epidemiology, and End Results database. RESULTS At a median follow-up of 12.73 years (range, 0.02-33 years), only 93 deaths (7.7%) were recorded, and the 20-year OS rate was 90.1% ± 1.1%. Children with neurofibromatosis type 1 had excellent survival and no tumor-related deaths during adulthood. Adverse risk factors included pleomorphic xanthoastrocytoma (P <.001) and a thalamic location (P <.001). For patients with unresectable tumors surviving more than 5 years after the diagnosis, upfront radiotherapy was associated with an approximately 3-fold increased risk of overall late deaths (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.6-6.6; P =.001) and an approximately 4-fold increased risk of tumor-related deaths (HR, 4.4; 95% CI, 1.3-14.6; P =.013). In a multivariate analysis, radiotherapy was the most significant factor associated with late all-cause deaths (HR, 3.0; 95% CI, 1.3-7.0; P =.012) and tumor-related deaths (HR, 4.4; 95% CI, 1.3-14.6; P = 0.014). A similar association between radiotherapy and late deaths was observed in the independent reference cohort (P <.001). In contrast to early deaths, late mortality was associated not with PLGG progression but rather with tumor transformation and non-oncological causes. CONCLUSIONS The course of PLGG is associated with excellent long-term survival, but this is hampered by increased delayed mortality in patients receiving upfront radiotherapy. These observations should be considered when treatment options are being weighed for these patients. Cancer 2016;122:1261-9.

Original languageEnglish
Pages (from-to)1261-1269
Number of pages9
JournalCancer
Volume122
Issue number8
DOIs
Publication statusPublished - 15 Apr 2016
Externally publishedYes

Keywords

  • children
  • glioma
  • low-grade
  • neurofibromatosis type 1 (NF1)
  • outcome
  • radiation

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