Adult brainstem gliomas: Correlation of clinical and molecular features

Abstract

Background Brainstem gliomas are rare in adults and overall have superior survival outcomes compared to pediatric brainstem gliomas. Patients and methods We conducted a retrospective data and tissue analysis of all adult patients (≥18 years old) with World Health Organization (WHO) Grade II, III, and IV brainstem gliomas in the University of Texas MD Anderson Cancer Center institutional database from 1990 to 2012. Results We identified 143 cases in adults ages 18 and over. There were 28 glioblastomas, 43 anaplastic astrocytomas, 15 diffuse astrocytomas, and 11 gliomas not otherwise specified, and in 46 cases the diagnosis was made radiographically. 128 (89.5%) cases were classified radiographically as diffuse and of the focal tumors, 9 of the 15 were WHO Grade III or IV tumors. Increasing tumor grade and contrast enhancement were associated with significantly reduced overall survival. The median overall survival for the entire cohort was 32.1 months similar to previously published studies. Two of 25 grade II and III tumors, and 1 of 17 glioblastomas had IDH1 mutations on immunohistochemical testing. Nine cases had sufficient tissue for mutation profiling, 1 case had a BRAF V600E mutation and 2 had 2 PIK3CA mutations. Conclusions Survival outcomes for adult WHO Grade II to IV brainstem gliomas were similar to supratentorial IDH1 wild-type tumors of similar grade and histology. Potentially actionable mutations can be identified from small biopsy samples in a subset of adult brainstem gliomas.

Adult brainstem gliomas

“…7,10 Higher pathologic grade, age >40 years at the time of diagnosis, and non-Caucasian ethnicity have been identified as unfavorable prognostic factors 10 (Table 1). 3 In general, although brainstem gliomas in adults represent malignant tumors, the overall prognosis appears to be more favorable compared with that for brainstem gliomas in children. Those authors also identified an association between improved overall survival and initial treatment with radiation or radiochemotherapy compared with supportive care only.…”

“…Focal malignant brainstem gliomas (25%-39% of tumors), tectal gliomas (3%-8% of tumors) and other brainstem tumors (15% of tumors) are less frequent (Fig. 3,8,9 Attributable to the anatomic location of these tumors, the presenting signs and symptoms include cranial nerve dysfunction (up to 87% of patients), gait disturbances (up to 61% of patients), and long-tract signs (up to 58% of patients). 2,6,7 However, other classifications based on histologic grade and tumor location have been used.…”

Multisession CyberKnife Stereotactic Radiosurgery for Brainstem Glioma

“…The median survival time for adult brainstem glioma is 30 months to 40 months, while pediatric Diffuse Intrinsic Pontine Glioma (DIPG) is associated with a dismal prognosis of 10 months to 12 months [2]. Resection is often not possible, and even biopsies are challenging and with significant risk for complications [3].…”

Rotating Gamma System Irradiation: A Promising Treatment for Low-grade Brainstem Gliomas

“…Such tumors include low-and high-grade lesions. The median survival time for patients with a brainstem glioma is about 10 months in children and 30-40 months in adult patients (5). The prognosis depends on the grade according to the World Health Organization (WHO) (6).…”

“…The prognosis depends on the grade according to the World Health Organization (WHO) (6). In a retrospective study from the United States, median survival was 77 months for patients with WHO grade II lesions, 21 months for those with grade III lesions and 15 months for those with grade IV lesions (5). A great amount of research has been carried out on the treatment of higher grade (III or IV) lesions, whereas fewer data are available for patients with low-grade (grade II) gliomas (7)(8)(9)(10)(11).…”