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Radiological Evaluation of Newly Diagnosed Non-Brainstem Pediatric High-Grade Glioma in the HERBY Phase II Trial.
- Source :
-
Clinical cancer research : an official journal of the American Association for Cancer Research [Clin Cancer Res] 2020 Apr 15; Vol. 26 (8), pp. 1856-1865. Date of Electronic Publication: 2020 Jan 10. - Publication Year :
- 2020
-
Abstract
- Purpose: The HERBY trial evaluated the benefit of the addition of the antiangiogenic agent Bevacizumab (BEV) to radiotherapy/temozolomide (RT/TMZ) in pediatric patients with newly diagnosed non-brainstem high-grade glioma (HGG). The work presented here aims to correlate imaging characteristics and outcome measures with pathologic and molecular data.<br />Experimental Design: Radiological, pathologic, and molecular data were correlated with trial clinical information to retrospectively re-evaluate event-free survival (EFS) and overall survival (OS).<br />Results: One-hundred thirteen patients were randomized to the RT/TMZ arm ( n = 54) or the RT/TMZ+BEV (BEV arm; n = 59). The tumor arose in the cerebral hemispheres in 68 patients (Cerebral group) and a midline location in 45 cases (Midline group). Pathologic diagnosis was available in all cases and molecular data in 86 of 113. H3 K27M histone mutations were present in 23 of 32 Midline cases and H3 G34R/V mutations in 7 of 54 Cerebral cases. Total/near-total resection occurred in 44 of 68 (65%) Cerebral cases but in only 5 of 45 (11%) Midline cases ( P < 0.05). Leptomeningeal metastases (27 cases, 13 with subependymal spread) at relapse were more frequent in Midline (17/45) than in Cerebral tumors (10/68, P < 0.05). Mean OS (14.1 months) and EFS (9.0 months) in Midline tumors were significantly lower than mean OS (20.7 months) and EFS (14.9 months) in Cerebral tumors ( P < 0.05). Pseudoprogression occurred in 8 of 111 (6.2%) cases.<br />Conclusions: This study has shown that the poor outcome of midline tumors (compared with cerebral) may be related to (1) lesser surgical resection, (2) H3 K27M histone mutations, and (3) higher leptomeningeal dissemination.<br /> (©2020 American Association for Cancer Research.)
- Subjects :
- Adolescent
Bevacizumab administration & dosage
Brain Neoplasms diagnostic imaging
Brain Neoplasms genetics
Brain Neoplasms therapy
Child
Child, Preschool
Combined Modality Therapy
Female
Glioma diagnostic imaging
Glioma genetics
Glioma therapy
Histones genetics
Humans
Male
Mutation
Neoplasm Grading
Neoplasm Recurrence, Local diagnostic imaging
Neoplasm Recurrence, Local genetics
Neoplasm Recurrence, Local therapy
Retrospective Studies
Survival Rate
Temozolomide administration & dosage
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Brain Neoplasms pathology
Chemoradiotherapy mortality
Glioma pathology
Neoplasm Recurrence, Local pathology
Neurosurgical Procedures mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3265
- Volume :
- 26
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Clinical cancer research : an official journal of the American Association for Cancer Research
- Publication Type :
- Academic Journal
- Accession number :
- 31924736
- Full Text :
- https://doi.org/10.1158/1078-0432.CCR-19-3154