Factors Affecting Survival of Children with Malignant Gliomas

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Abstract
Forty-four patients (23 male and 21 female, aged 2 to 20 years (mean, 9.6)), harboring pathologically proven malignant glioma (Grades III and IV) were treated between 1976 and 1985. Tumor sites included the cerebral hemisphere (26 patients), thalamus (6 cases), brain stem (7 cases), and the cerebellum (5 cases). All patients underwent operation and initial treatment with steroids. Irradiation was given in 35 patients; 3 had adjuvant chemotherapy. At the time of study, 22 were deceased. The longest period of follow-up was 65 months. Survival curves were calculated from the date of the first visit to the date of the last evaluation or death. The mean survival times were 30 months for all patients, 14 months for cerebellar cases, 17 months for brain stem cases, 26 months for thalamic cases, and 33 months for cerebral hemisphere cases. However, the differences between mean survival times were not statistically significant. The patient's age was the single most significant factor, with those 5 to 10 years old having the worst survival curve (P= 0.0036). Irradiation was associated with an improved mean survival time (34 vs. 19 months); however, this was not statistically significant (P= 0.15). Girls had shorter mean survival times than boys (16.5 vs. 37 months, P= 0.0511). Otherwise, there was no clinical or radiological factor that indicated a better prognosis. This was also confirmed by x2analyses comparing 72 factors between patients with more than 24 months of survival and those with less than 24 months of survival. In particular, tumor size (greater or less than 5 cm), the presence of neurological deficits, the level of consciousness, increased intracranial pressure, hydrocephalus, calcium or cyst on a computed tomographic scan, and histological grading (III or IV) showed no significant correlations.