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Survival outcomes in pediatric recurrent high-grade glioma: results of a 20-year systematic review and meta-analysis

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Abstract

Recurrent pediatric high-grade glioma is a leading cause of cancer-related death in children. We report results of a systematic review and meta-analysis investigating survival outcome in pediatric patients with recurrent high-grade glioma over the last 20 years. MEDLINE/PubMed, EMBASE, Web of Science and Cochrane Review databases were searched for relevant studies reporting on survival outcomes for pediatric patients with recurrent high-grade glioma treated between 1996 and 2016. Progression-free survival (PFS) and overall survival (OS) were calculated cumulatively over all studies, by therapy subgroup, and by decade of treatment. Random effects models were used to control for heterogeneity as measured by the I2 statistic. A total of 17 studies across 4 treatment strategies were included. Eleven investigated traditional chemotherapy, 1 investigated targeted therapy, 3 investigated immunotherapy, and 2 investigated radiotherapy. A total of 129 patients were included with a median age of 10.0 years. Cumulative PFS was 3.5 months (95% CI 2.1–5.0). Cumulative OS was 5.6 months (95% CI 3.9–7.3). OS was 4.0 months (95% CI 1.9–6.1) using traditional chemotherapy, 9.3 months using targeted therapies (95% CI 5.4–13), 6.9 months using immunotherapy (95% CI 2.1–12), and 14 months using reirradiation (95% CI 2.8–25). OS between 1996 and 2006 was 4.2 months (95% CI 2.1–6.2) compared to 8.5 months (95% CI 5.6–11) after 2006. Pediatric patients with recurrent high-grade glioma suffer from poor PFS and OS, regardless of therapy. There may be a trend towards improved OS in the last decade.

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Acknowledgements

C.N.K. is supported by the National Institutes of Health T32 Grant (T32CA128583-07), UCSF Clinical and Translational Science Institute Strategic Opportunities Support Program (UL1 TR001872), Alex’s Lemonade Stand Foundation (A120729), and Frank A. Campini Foundation. S.M. is supported by the National Institutes of Health National Center for Advancing Translational Sciences through UCSF-CTSI (KL2TR000143). This work was presented as a podium presentation at the 4th Pediatric Neuro-Oncology Basic and Translational Research Conference in New York, NY on June 16, 2017 and as an eTalk at the Society of Neuro-Oncology Annual Meeting on November 17, 2017.

Funding

No external funding was used to directly support this study.

Author information

Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA, 94158, USA

    Cassie Kline & Sabine Mueller

  2. Department of Neurology, University of California, San Francisco, 550 Sandler Neurosciences, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA, 94158, USA

    Cassie Kline, Erin Felton & Sabine Mueller

  3. Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, San Francisco, CA, 94158, USA

    I. Elaine Allen

  4. UCSF Library, University of California, San Francisco, 530 Parnassus Avenue, San Francisco, CA, 94143, USA

    Peggy Tahir

  5. Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA, 94143, USA

    Sabine Mueller

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Correspondence to Cassie Kline.

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Electronic Supplementary Material

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11060_2017_2701_MOESM1_ESM.docx

Table of all studies included in final statistical analyses. Thio = thiotepa; BCNU = carmustine; O6-BG = O6-benzylguanine; TMZ = temozolomide; Chemo = varied chemotherapy; Topo = topotecan; Carbo = carboplatin; HD = high-dose; ASCR = autologous stem cell rescue; Etopo = etoposide; DC = dendritic cell. (DOCX 105 KB)

Forest plot representing PFS by therapy (TIFF 1522 KB)

Forest plot representing PFS by decade (TIFF 1522 KB)

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Kline, C., Felton, E., Allen, I.E. et al. Survival outcomes in pediatric recurrent high-grade glioma: results of a 20-year systematic review and meta-analysis. J Neurooncol 137, 103–110 (2018). https://doi.org/10.1007/s11060-017-2701-8

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