Clinico-radiologic characteristics of long-term survivors of diffuse intrinsic pontine glioma

Abstract

Diffuse intrinsic pontine glioma (DIPG) is the deadliest central nervous system tumor in children. The survival of affected children has remained poor despite treatment with radiation therapy (RT) with or without chemotherapy. We reviewed the medical records of all surviving patients with DIPG treated at our institution between October 1, 1992 and May 31, 2011. Blinded central radiologic review of the magnetic resonance imaging at diagnosis of all surviving patients and 15 controls with DIPG was performed. All surviving patients underwent neurocognitive assessment during follow-up. Five (2.6%) of 191 patients treated during the study period were surviving at a median of 9.3 years from their diagnosis (range, 5.3 to 13.2 years). Two patients were younger than 3 years, one lacked signs of pontine cranial nerve involvement, and three had longer duration of symptoms at diagnosis. One patient had a radiologically atypical tumor and one had a tumor originating in the medulla. All five patients received RT. Chemotherapy was variable among these patients. Neurocognitive assessments were obtained after a median interval of 7.1 years. Three of four patients who underwent a detailed evaluation showed cognitive function in the borderline or mental retardation range. Two patients experienced disease progression at 8.8 and 13 years after diagnosis. A minority of children with DIPG experienced long-term survival with currently available therapies. These patients remained at high risk for tumor progression even after long follow-ups. Four of our long-term survivors had clinical and radiologic characteristics at diagnosis associated with improved outcome.

A multi-institutional study of brainstem gliomas in children with neurofibromatosis type 1

“…This is in contrast to sporadic BSGs, where pontine involvement is most common. [12][13][14] Second, half of the NF1-BSG cases in our series were identified as incidental findings on MRI, which is a similar proportion to that reported in previous studies. 5 The incidental identification of these tumors in the setting of NF1 is important, as MRI scans in children with NF1 frequently reveal nonenhancing T2 hyperintense lesions within the brainstem, which historically have been difficult to distinguish from gliomas.…”

Pre-radiation chemotherapy improves survival in pediatric diffuse intrinsic pontine gliomas

“…Children who were less than 3 years old at the time of diagnosis were thought to have a better prognosis [22][23][24], and this suspected influence of age may be explained by specific molecular differences [14]. Age could not explain the differences between our two groups as all patients in our study were older than 3 years.…”

Gliomatosis cerebri in children shares molecular characteristics with other pediatric gliomas

“…Despite the use of aggressive therapy, GC still portends one of the poorest prognoses of all pediatric CNS cancers, probably only surpassed by diffuse intrinsic pontine gliomas [14]. We report clinicopathologic and radiological characteristics in the largest cohort to date of pediatric GC.…”