Pediatric glioblastoma: clinico-radiological profile and factors affecting the outcome

• Published in: Child's nervous system Vol. 28; no. 12; pp. 2055 - 2062
• Main Authors: Das, Kuntal Kanti, Mehrotra, Anant, Nair, Anup P., Kumar, Shaleen, Srivastava, Arun K., Sahu, Rabi N., Kumar, Raj
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-12-2012
• Subjects: Adolescent; Age Factors; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - pathology; Brain Neoplasms - therapy; Child; Child, Preschool; Disease-Free Survival; Female; Glioblastoma - diagnostic imaging; Glioblastoma - pathology; Glioblastoma - therapy; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Karnofsky Performance Status; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Neurosurgical Procedures; Original Paper; Postoperative Complications - epidemiology; Radiography; Retrospective Studies; Sex Factors; Survival Analysis; Treatment Outcome; Clinical; Pediatric; Pathological; Surgery; Outcome; Glioblastoma
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-012-1890-x

Background and purpose
Glioblastoma in the pediatric age group is relatively rare. As a result, it has been difficult to deduce any consistent clinico-radiological and pathological profiles on these patients. Also, the prognostic factors affecting the survival in pediatric glioblastoma are not as well defined as in adults.
Patients and methods
In this retrospective series, 65 pediatric patients (age ≤ 18 years) from January 1995 to December 2011 with histopathologically proven diagnosis of intracranial glioblastoma were studied. Clinico-radiological, pathological, treatment, and follow-up data were collected. Progression-free and overall survivals were assessed using the Kaplan–Meier method.
Results
The male-to-female ratio was 2.6:1 with a mean age of 13.29 ± 4.53 years (range 2–18 years). Headache with or without vomiting (
n
 = 51, 78 %), followed by seizures (
n
 = 42, 65 %), and focal deficits (
n
 = 31, 47 %) were the leading symptoms. Forty-nine (75 %) patients had tumors located superficially, whereas there were 16 patients with deeply located glioblastomas (25 %). Gross total tumor excision was achieved in 43 (66 %) patients, while the remaining patients had incomplete excision (
n
 = 22, 34 %). Mean follow-up was 17.7 months (range 1.5–119 months). The median progression-free and overall survivals were 10 and 20 months, respectively. Extent of resection was found to be the independent predictor of survival (
p
value = 0.002).
Conclusion
Pediatric glioblastomas are associated with longer progression-free as well as overall survivals. Extent of tumor resection is the strongest predictor of survival in pediatric glioblastoma. Hence, an aggressive surgical resection may fetch a better outcome in children with glioblastoma.