Long-term treatment outcomes of pediatric low-grade gliomas treated at a university-based hospital

Abstract Purpose A multimodality approach is generally considered for pediatric low-grade gliomas (LGG); however, the optimal management remains uncertain. The objective of the study was to evaluate treatment outcomes of pediatric LGG, focusing on long-term survival and factors related to outcomes. Methods A retrospective review of 77 pediatric LGG cases treated at Ramathibodi Hospital, Thailand between 2000 and 2018 was performed. The inclusion criteria were all pediatric LGG cases aged ≤ 15 years. Diffuse intrinsic pontine gliomas and spinal cord tumors were excluded. Results The median follow-up time was 8.2 years (range, 0.6–19.7). The median age at diagnosis was 6.2 years (interquartile range, 3.6–11.4). Treatments included surgery (71%), chemotherapy (40%), and radiation therapy (14%). The 10-year overall survival (OS) and 10-year progression-free survival were 94% and 59%, respectively, for the entire cohort. The 10-year OS was 100% in three subgroups of patients: pilocytic subtype, WHO grade 1 tumors, and receipt of gross total resection. After multivariable analysis, older age and no surgery had a significant negative impact on OS. Conclusions Excellent outcomes can be achieved in pediatric LGG patients using a multidisciplinary approach. Gross total resection is the standard primary treatment. Chemotherapy is the alternative standard treatment in incomplete resection cases, unresectable patients, or patients with progressive disease. Radiation therapy should be reserved as a salvage treatment option because of late complications that usually affect patients’ quality of life.