Department of Radiation Oncology and Mallinkrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Int J Radiat Oncol Biol Phys. 2011 Jul 15;80(4):1117-21. doi: 10.1016/j.ijrobp.2010.03.013. Epub 2011 Jan 8.
Current treatment recommendations for pediatric glioblastoma include surgery, chemotherapy, and radiation therapy. However, even with this multispecialty approach, overall survival remains poor. To assess outcome and evaluate treatment-related prognostic factors, we retrospectively reviewed the experience at our institution.
Twenty-four glioblastoma patients under the age of 21 were treated with radiation therapy with curative intent at Washington University, St. Louis, from 1970 to 2008. Patients underwent gross total resection, subtotal resection or biopsy alone. Fourteen (58%) of the patients received chemotherapy. All patients received radiation therapy. Radiation consisted of whole-brain radiation therapy in 7 (29%) patients with a median dose of 50.4 Gy. Seventeen (71%) patients received three-dimensional conformal radiation therapy with a median dose of 54 Gy.
Median follow-up was 12.5 months from diagnosis. One and 2-year overall survival rates were 57% and 32%, respectively. Median overall survival was 13.5 months. There were no differences in overall survival based on patients' age, race, gender, tumor location, radiation volume, radiation dose, or the use of chemotherapy. There was a significant improvement in overall survival for patients in whom gross total resection was achieved (p = 0.023). Three patients were alive 5 years after gross total resection, and 2 patients were alive at 10 and 24 years after diagnosis.
Survival for children with glioblastoma remains poor. Data from this and other studies demonstrate the importance of achieving a gross total resection. Continued investigation into new treatment options is needed in an attempt to improve outcome for these patients.
目前针对小儿脑胶质瘤的治疗建议包括手术、化疗和放疗。然而，即使采用多学科综合治疗方法，整体存活率仍然较差。为了评估结果并评估与治疗相关的预后因素，我们回顾性地分析了本机构的经验。
1970 年至 2008 年，华盛顿大学圣路易斯分校对 24 名年龄在 21 岁以下的脑胶质瘤患者采用有治愈意图的放疗进行治疗。患者行全切除、次全切除或单纯活检。14 名（58%）患者接受化疗。所有患者均接受放疗。放疗包括 7 名（29%）患者的全脑放疗，中位剂量为 50.4Gy。17 名（71%）患者接受三维适形放疗，中位剂量为 54Gy。
中位随访时间为诊断后 12.5 个月。1 年和 2 年的总生存率分别为 57%和 32%。中位总生存率为 13.5 个月。患者的年龄、种族、性别、肿瘤位置、放疗范围、放疗剂量或化疗的使用与总生存率无差异。对于实现大体全切除的患者，总生存率有显著改善（p=0.023）。3 名患者在大体全切除后 5 年仍存活，2 名患者在诊断后 10 年和 24 年仍存活。
儿童脑胶质瘤的存活率仍然较差。本研究和其他研究的数据表明，实现大体全切除非常重要。需要继续研究新的治疗方案，以试图改善这些患者的预后。
