Aktualisiert am 6.8.08
Gliome niedrigen Malignitätsgrades im Kindes- und Jugendalterhttp://www.uni-duesseldorf.de/AWMF/ll/025-024.htmIch zitiere aus dem ersten Absatz:
Gliome niedrigen Malignitätsgrades stellen 30-40% der primären Hirntumoren des Kindesalters und kommen in allen Abschnitten des ZNS vor. Das mediane Erkrankungsalter liegt bei fünf bis sieben Jahren, die männliche Prädisposition dokumentiert sich in einem Geschlechterverhältnis von 1,5 : 1. Bei ca. 10% der Patienten liegt als Grunderkrankung eine Phakomatose (Neurofibromatose von Recklinghausen NF I, tuberöse Sklerose) vor. Während WHO-Grad I-Tumoren im Allgemeinen abgrenzbar sind vom umgebenden Hirngewebe, weisen WHO-Grad II-Tumoren bereits eine diffuse Infiltrationszone auf. Das Wachstum der Tumoren ist meist lokal. Über das Risiko einer primären oder sekundären Entstehung multifokaler Tumoren auf dem Liquorweg liegen keine systematischen, prospektiven Untersuchungen vor. Im Rahmen retrospektiver Untersuchungen wird die Frequenz mit 5-10% angegeben und scheint erhöht zu sein bei jüngeren Kindern mit chiasmatisch-hypothalamischen Tumoren. Der Tumorzellnachweis im Liquor ist eine Rarität. Zum Risiko einer systemischen Metastasierung ohne oder mit Shuntsystem liegen nur Einzelfallberichte vor.
Einige Arbeiten über Astrozytome bei Kindern (über
PubMed recherchiert)
Update on new treatments and developments in childhood brain tumors. Quelle: Current Opinion in Pediatrics. 19(6):670-674, December 2007.
Partap, Sonia a; Fisher, Paul Graham a,b,c,d
Zitat:
Abstract: Purpose of review: Childhood primary central nervous system tumors remain a therapeutic conundrum. As the second most common pediatric cancer, brain tumors lead to significantly worse survival and long-term effects compared with those seen with hematologic malignancies and other solid tumors. This review discusses current management strategies in three pediatric brain tumors, the long-term effects of therapy, as well as novel laboratory findings that may alter future treatment strategies.
Recent findings: The current literature focuses on tactics to predict those at risk of treatment failure and long-term effects. By analyzing tumors at a molecular genetics level rather than traditional histology, new data have begun to emerge on methods to begin to consider targeted therapies, tailored to the individual child. Furthermore, as survivorship has improved with current radiation and chemotherapy regimens, long-term effects have been identified and merit clinical attention.
Summary: Even though long-term survival for children with a brain tumor approaches 70%, the need for improved treatment regimens is striking. Secondary malignancies, neurocognitive deficits and treatment failure continue to afflict these children and young adults. The current review will inform clinicians of the challenges faced by basic scientists and clinicians when treating brain tumors, and point to future research directions.
Quelle: Childs Nerv Syst. 2007 Mar;23(3):315-9. Epub 2006 Oct 13.
Zitat:
Astrocytic tumors in children: treatment results from a single institution.
Varan A, Akyüz C, Akalan N, Atahan L, Söylemezoglu F, Selek U, Yalçin B, Kutluk T, Büyükpamukçu M.
Department of Pediatric Oncology, Institute of Oncology, Hacettepe University, 06100 Ankara, Turkey. hupog@tr.net
OBJECTIVE: The aims of this study are to evaluate the patients with astrocytomas and to investigate survival rates and prognosis.
PATIENTS AND METHODS: Five hundred fourteen patients diagnosed with brain tumor between 1972 and 2003 were retrospectively analyzed. Three different chemotherapy regimens were used according to years. CCNU-based protocols were used in the early years; COPP (cyclophosphamide, oncovin, procarbazine, prednisolone) and CDDP+VP16 (cisplatinum + etoposide) were the other protocols used in the following years. Radiotherapy was used after 3 years of age according to protocols.
RESULTS: Ninety-eight (19%) out of 514 patients have astrocytic histopathology. The histopathologic distribution was as follows: low grade, 55 patients; high grade, 43 patients. COPP regimen was given to 24 patients, CCNU-based regimen to 13, and CDDP+VP16 to 10 patients. We did not use any chemotherapy in 51 patients. Overall survival (OS) and event free-survival rates were 59.2 and 45.7% in whole group. OS rates were 93.3 and 22.4% for low-grade and high-grade histopathology, respectively (p=0.0001). OS for CCNU, CDDP+VP16, and COPP were 35.9, 22.8, and 30.4%, respectively.
CONCLUSION: Low-grade astrocytomas are highly responsive to the surgery, and they do not need any further treatment unless the patient has relapse or recurrence. Still, the treatment of the high-grade tumors is a problem, and it needs new treatment approaches.
Quelle: Cancer. 2005 Dec 15;104(12):2862-71.
Zitat:
Phase II study of high-dose chemotherapy before radiation in children with newly diagnosed high-grade astrocytoma: final analysis of Children's Cancer Group Study 9933.
MacDonald TJ, Arenson EB, Ater J, Sposto R, Bevan HE, Bruner J, Deutsch M, Kurczynski E, Luerssen T, McGuire-Cullen P, O'Brien R, Shah N, Steinbok P, Strain J, Thomson J, Holmes E, Vezina G, Yates A, Phillips P, Packer R.
Department of Hematology-Oncology, Children's National Medical Center, Washington, DC 20010, USA. tmacdona@cnmc.org
BACKGROUND: High-grade astrocytomas (HGA) carry a dismal prognosis and compose nearly 20% of all childhood brain tumors. The role of high-dose chemotherapy (HDCT) in the treatment of HGA remains unclear.
METHODS: In a nationwide study, The Children's Cancer Group (CCG) prospectively evaluated 102 children with HGA and postoperative residual disease for efficacy and toxicity of four courses of HDCT before radiotherapy (RT). Patients were randomly assigned to one of three couplets of drugs: carboplatin/etoposide (Regimen A), ifosfamide/etoposide (Regimen B), or cyclophosphamide/etoposide (Regimen C). After HDCT, all patients were to receive local RT followed by lomustine and vincristine. Twenty-six patients were excluded after central neuroradiographic review (n = 8) or pathology review (n = 18).
RESULTS: Of 76 evaluable patients (median age, 11.95 yrs; range, 3-20 yrs), 30 patients relapsed during HDCT, and 11 others did not complete HDCT because of toxicity. Nonhematologic serious toxicities were common (29%), and 21% of patients did not receive RT. Objective response rates were not associated with amount of residual disease and did not statistically differ between regimens: 27% (Regimen A), 8% (Regimen B), and 29% (Regimen C). Overall survival (OS) was 24% +/- 5% at 5 years and did not differ between groups. Median time to an event was longest for Regimen A (283 days compared with 83 and 91 days for Regimens B and C, respectively). The five-year, event-free survival (EFS) rate for all patients was 8% +/- 3% and 14% +/- 7% for Regimen A (P = 0.07).
CONCLUSIONS: OS and EFS were not affected by histologic grade. Patients who responded to HDCT had a nominally higher survival rate (P = 0.03 for trend). The authors conclude that these commonly used HDCT regimens provide no additional clinical benefit to conventional treatment in HGA, regardless of the amount of measurable residual tumor. Copyright 2005 American Cancer Society.
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