Temporal changes in treatment and late mortality and morbidity in adult survivors of childhood glioma: a report from the Childhood Cancer Survivor Study.

in Nature cancer by Peter M K de Blank, Katharine R Lange, Mengqi Xing, Sedigheh Mirzaei Salehabadi, Deokumar Srivastava, Tara M Brinkman, Kirsten K Ness, Kevin C Oeffinger, Joseph Neglia, Kevin R Krull, Paul C Nathan, Rebecca Howell, Lucie M Turcotte, Wendy Leisenring, Gregory T Armstrong, M Fatih Okcu, Daniel C Bowers

TLDR

  • This study looked at how the treatment for a type of brain tumor called glioma has changed over time. They found that people who got treatment more recently were less likely to have bad health problems later on and less likely to get another tumor. The study also found that avoiding radiation was the best way to improve outcomes for these patients.

Abstract

Pediatric glioma therapy has evolved to delay or eliminate radiation for low-grade tumors. This study examined these temporal changes in therapy with long-term outcomes in adult survivors of childhood glioma. Among 2,501 5-year survivors of glioma in the Childhood Cancer Survivor Study diagnosed 1970-1999, exposure to radiation decreased over time. Survivors from more recent eras were at lower risk of late mortality (≥5 years from diagnosis), severe/disabling/life-threatening chronic health conditions (CHCs) and subsequent neoplasms (SNs). Adjusting for treatment exposure (surgery only, chemotherapy, or any cranial radiation) attenuated this risk (for example, CHCs (1990s versus 1970s), relative risk (95% confidence interval), 0.63 (0.49-0.80) without adjustment versus 0.93 (0.72-1.20) with adjustment). Compared to surgery alone, radiation was associated with greater than four times the risk of late mortality, CHCs and SNs. Evolving therapy, particularly avoidance of cranial radiation, has improved late outcomes for childhood glioma survivors without increased risk for late recurrence.

Overview

  • The study examines temporal changes in pediatric glioma therapy and its impact on long-term outcomes in adult survivors of childhood glioma diagnosed between 1970-1999. The hypothesis being tested is whether exposure to radiation decreases over time and if it affects the risk of late mortality, severe/disabling/life-threatening chronic health conditions (CHCs), and subsequent neoplasms (SNs).
  • The methodology used for the experiment includes a cohort study of 2,501 5-year survivors of glioma in the Childhood Cancer Survivor Study. The study includes demographic information, treatment exposure (surgery only, chemotherapy, or any cranial radiation), and long-term outcomes. Specific procedures or tests conducted include follow-up assessments for CHCs and SNs. The primary objective of the study is to examine the temporal changes in therapy and its impact on long-term outcomes in adult survivors of childhood glioma.

Comparative Analysis & Findings

  • The study compares the outcomes observed under different experimental conditions or interventions, specifically exposure to radiation. The results show that survivors from more recent eras were at lower risk of late mortality, CHCs, and SNs. Adjusting for treatment exposure attenuated this risk. Compared to surgery alone, radiation was associated with greater than four times the risk of late mortality, CHCs, and SNs. The key findings of the study suggest that evolving therapy, particularly avoidance of cranial radiation, has improved late outcomes for childhood glioma survivors without increased risk for late recurrence.

Implications and Future Directions

  • The study's findings have significant implications for the field of research and clinical practice. The results suggest that evolving therapy has improved late outcomes for childhood glioma survivors without increased risk for late recurrence. However, the study also identifies limitations, such as the need for more recent data to fully understand the impact of evolving therapy on long-term outcomes. Future research directions could include a larger cohort study with more recent data and a focus on the impact of evolving therapy on late recurrence. Additionally, the study highlights the importance of continued research to improve outcomes for childhood glioma survivors.
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