Long-term follow-up data support the decreased use of radiation and increased use of surgery seen in pediatric patients with glioma in recent years, according to researchers. 

The data were presented at the 20th International Symposium on Pediatric Neuro-Oncology (ISPNO).

Researchers set out to evaluate long-term outcomes of evolving treatment strategies from the 1970s through the 1990s. The team analyzed data from 5-year survivors of childhood glioma enrolled in the Childhood Cancer Survivor Study.

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Survivors (n=2684) were stratified by treatment decade — 1970s (n=508), 1980s (n=958), and 1990s (n=1218). In each group, roughly half of survivors were male, and more than 75% were White.

Use of radiation decreased over time, from 63.5% in the 1970s to 52.5% in the 1980s and 28.3% in the 1990s. Use of surgery alone increased from 34.6% to 41.9% to 52.1%. Use of chemotherapy with or without surgery increased from 2.0% to 5.6% to 19.5%. Use of platinum agents increased from 5.1% to 39.6% and 60.9%.

The risk of all-cause mortality was significantly decreased for patients treated in the 1980s (relative risk [RR], 0.75; 95% CI, 0.60-0.94) and 1990s (RR, 0.54; 95% CI, 0.41-0.71), compared with patients treated in the 1970s. 

All-cause mortality was significantly increased among patients who received any brain radiation (RR, 4.95; 95% CI, 3.79-6.47) or chemotherapy with or without surgery (RR, 2.88; 95% CI, 1.85-4.48), compared with surgery alone.

Similar trends were seen for subsequent neoplasms. The risk of subsequent neoplasms was decreased for patients treated in the 1980s (RR, 0.72; 95% CI, 0.52-0.99) and 1990s (RR, 0.64; 95% CI, 0.44-0.94), but it was increased for patients who received radiation (RR, 4.33; 95% CI, 3.06-6.13) or chemotherapy with or without surgery (RR, 2.08; 95% CI, 1.03-4.23).

The risk of grade 3-5 chronic health conditions was decreased for patients who were treated in the 1990s (RR, 0.65; 95% CI, 0.51-0.82) and increased for patients who underwent radiation (RR, 4.20; 95% CI, 3.38-5.24) or chemotherapy (RR, 1.66; 95% CI, 1.13-2.45).

The researchers concluded that late outcomes of pediatric glioma survivors support the change in treatment strategy over time, favoring surgical-only approaches over brain radiation exposure and, to a lesser extent, chemotherapy exposure. Additional study is needed to evaluate late outcomes of novel targeted therapies.


de Blank PMK, Lange KR, Xing M, et al. Late mortality and morbidity of adult survivors of childhood glioma treated across three decades: A report from the Childhood Cancer Survivor Study. Presented at ISPNO 2022; June 12-15, 2022. Abstract LGG-15.