Prognostic factors in adult brainstem glioma: a tertiary care center analysis and review of the literature

Abstract

Introduction Adult brainstem gliomas (BSGs) are rare central nervous system tumours characterized by a highly heterogeneous clinical course. Median survival times range from 11 to 84 months. Beyond surgery, no treatment standard has been established. We investigated clinical and radiological data to assess prognostic features providing support for treatment decisions. Methods 34 BSG patients treated between 2000 and 2019 and aged ≥ 18 years at the time of diagnosis were retrospectively identified from the databases of the two largest Austrian Neuro-Oncology centres. Clinical data including baseline characteristics, clinical disease course, applied therapies, the outcome as well as neuroradiological and neuropathological findings were gathered and analysed. The tumour apparent diffusion coefficient (ADC), volumetry of contrast-enhancing and non-contrast-enhancing lesions were determined on magnetic resonance imaging scans performed at diagnosis. Results The median age at diagnosis was 38.5 years (range 18–71 years). Tumour progression occurred in 26/34 (76.5%) patients after a median follow up time of 19 months (range 0.9–236.2). Median overall survival (OS) and progression-free survival (PFS) was 24.1 months (range 0.9–236.2; 95% CI 18.1–30.1) and 14.5 months (range 0.7–178.5; 95% CI 5.1–23.9), respectively. Low-performance status, high body mass index (BMI) at diagnosis and WHO grading were associated with shorter PFS and OS at univariate analysis (p < 0.05, log rank test, respectively). ADC values below the median were significantly associated with shorter OS (14.9 vs 44.2 months, p = 0.018). Conclusion ECOG, BMI, WHO grade and ADC values were associated with the survival prognosis of BSG patients and should be included in the prognostic assessment.

Compassionate Treatment of Brainstem Tumors with Boron Neutron Capture Therapy: A Case Series

“…Brainstem gliomas remains a challenging tumor type due to their highly heterogenous clinical features, with many clinical trials failing to improve survival. Several studies have found that older age, lower KPS, higher tumor grade and appearance of necrosis are unfavorable prognostic factors for survival [32][33][34]. In our case series, however, age, KPS, and tumor grade did not appear to affect the efficacy of BNCT.…”

National Brain Tumour Registry of China (NBTRC) statistical report of primary brain tumours diagnosed in China in years 2019–2020

“…For example, brainstem glioma can have a few categories of glioma in different more specific sites, such as diffuse intrinsic pontine glioma (DIPG) with very poor survival and exogenous medulla glioma with excellent survival after successful operation. 20 It is convinced that only a well-designed brain tumour patients’ registry can provide more details on brain tumour patient characteristics as well as the disease burden.…”

Advancements in Image-Based Models for High-Grade Gliomas Might Be Accelerated

“…Leibetseder and collaborators studied the clinical and radiological parameters possibly influencing the prognosis of patients with brainstem gliomas (BSG). The ECOG Performance Status scale, the body mass index, the WHO grade and the ADC were proposed as possible parameters associated with the OS of BSG patients [132]. The prognosis of HGG patients is worse with advancing age.…”