Pediatric glioblastoma: Results with adjuvant chemoradiation using temozolomide.

Abstract

2072 Background: Paediatric glioblastoma patients are underrepresented in major trials for this disease. The value of concurrent and adjuvant temozolomide is not known in this subset of patients. Methods: We retrospectively analysed our database between 2004 and 2010. All patients were treated with maximally safe surgical resection. This was followed by a uniform treatment schedule of post-operative radiation according to RTOG guidelines with concurrent daily temozolomide at 75 mg per meter square. The radiation dose was 60 Gy in 30 fractions planned by 3 dimensional conformal radiotherapy. 4 weeks later, adjuvant temozolomide was started at 150 mg per meter square, day 1 to 5 every 28 days and escalated to 200 mg per meter square if well tolerated. Log-rank test was used to compare survival distribution. The data was analysed using SPSS 16. Results: 23 patients were analysed. The median age was 11 years (range: 5 to 19 years). 15 males and 8 females were noted. 4 patients had seizures at presentation while 19 did not. 13 patients underwent a gross total resection while 10 underwent a subtotal resection. 5 patients received only concurrent temozolomide while 18 received concurrent and adjuvant temozolomide. The median number of adjuvant temozolomide cycles were 6 (range 2 to 12). The median follow up was 11.9 months (range: 1.6 to 30.1 months). 6 patients were dead and 17 were alive at the time of analysis. The median overall survival was not reached. The median survival for patients receiving only concurrent temozolomide was 13 months while that for patients receiving concurrent and adjuvant temozolomide was not reached and the difference was statistically significant (p=0.0009). The overall survival was not statistically different for age less or more than 10 years, gender, and type of surgery or the number of adjuvant cycles of temozolomide (less or more than 6). Conclusions: Temozolomide may have a role in paediatric Glioblastoma. Both concurrent and adjuvant temozolomide seem to be important for superior overall survival in this group of patients.