Current Management of Brain Stem Gliomas

Edwards, Michael S. B.; Prados, Michael D.

doi:10.1159/000120349

Cited by 24 publications

(12 citation statements)

References 37 publications

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“…Brainstem gliomas are a heterogeneous group of neo plasms, both clinically and histologically [1,9]. Inherent in this fact is the marked variation in their ultimate out come.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, the behavior of these tumors is consistently favorable. Un like the diffuse brainstem neoplasms which often present with multiple cranial nerve palsies, long tract signs and rapid progression [1,4,10], quadrigeminal tumors gene rally present only with signs and symptoms of increased intracranial pressure [5. 6].…”

Section: Discussionmentioning

confidence: 99%

“…Radiation therapy has long also been utilized in the treatment of brainstem gliomas [1,10,19]. Three of our children underwent external beam irradiation.…”

Section: Discussionmentioning

confidence: 99%

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Gliomas of the Tectum and Periaqueductal Region of the Mesencephalon

et al. 1991

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Gliomas that arise in the tectal and periaqueductal region of the mesencephalon usually present with hydrocephalus secondary to occlusion of the aqueduct of Sylvius. A review of 486 brain tumors in children treated during a 5-year period revealed 6 children with gliomas of the tectal plate. The 6 children were shunted for hydrocephalus, presumed secondary to aqueductal stenosis, prior to establishing the diagnosis of tectal plate glioma. No abnormalities were noted on the initial, uncontrasted computed tomography (CT) scans. The tumors are isodense without contrast enhancement which makes the CT diagnosis difficult. Magnetic resonance imaging (MRI) is diagnostic and demonstrates the characteristic enlargement of the tectum with increased density on T2 images. T1 density and gadolinium enhancement are variable. Pathological confirmation was obtained by open biopsy in 2 patients, a stereotaxic biopsy was performed on 2 children; 2 children were not biopsied. The tumor histology obtained was that of pilocytic astrocytoma. Two patients were treated with radiation therapy at the time of diagnosis. One child was followed closely and subsequently irradiated after tumor progression. All patients in this series are alive and functioning adequately 2–10 years after the onset of symptoms.

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“…Brainstem gliomas are a heterogeneous group of neo plasms, both clinically and histologically [1,9]. Inherent in this fact is the marked variation in their ultimate out come.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gliomas of the Tectum and Periaqueductal Region of the Mesencephalon

et al. 1991

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“…The use of computed tomographic studies (CT) revolutionized the evaluation of brain stem gliomas as it allowed classifica tion of specific subsets of tumors with significantly differ ent prognoses and responses to therapy [5][6][7][8][9], The development of magnetic resonance imaging (MR) has facilitated the identification and diagnosis of brain stem tumors [10][11][12]. MR is more sensitive and spe cific than CT in the identification of tumor and in the deli neation of the extent of tumor [10][11][12][13]. It is as yet unpro ven whether MR. which often shows brain stem tumors to be more extensive than appreciated on CT, can be used to classify patients into prognostic subsets.…”

Section: Introductionmentioning

confidence: 99%

Brain Stem Gliomas: A Classification System Based on Magnetic Resonance Imaging

Barkovich¹,

Krischer²,

Kun³

et al. 1990

Pediatr Neurosurg

223

119

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MR scans of 87 pediatric patients with brain stem gliomas were retrospectively reviewed to develop a new classification scheme based on MR imaging. The scheme that has been developed utilizes primarily T2-weighted images, as these most accurately show tumor extent. Tumors are characterized as to location of origin, focality, direction and extent of tumor growth, degree of brain stem enlargement, degree of exophytic growth, and presence or absence of cysts, necrosis, hemorrhage, and hydrocephalus. The use of this classification allowed identification of differences in a population of patients who were selected to be as similar as possible. This system will aid in the assessment of new protocols for treatment of brain stem tumors.

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“…Approximately 10% of childhood brain tumors are located in the brain stem [1], Radiation therapy, either conventionally fractionated or hyperfractionated, has been the most frequently used treatment due to the unresectable nature of most brain stem tumors [2], The contri bution of chemotherapy has been disappointing. Few agents have shown significant activity and no survival benefit has been demonstrated when chemotherapy has been added to radiation therapy [3],…”

Section: Introductionmentioning

confidence: 99%

Hyperfractionated Irradiation and Concurrent Cisplatin in Brain Stem Tumors: A Pediatric Oncology Group Pilot Study (9139)

et al. 1994

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A phase I Pediatric Oncology Group Study was performed combining 7,020 cGy hyperfractionated irradiation (117 cGy twice daily separated by 6 h) with increasing concurrent doses of cisplatin given with the intent of radiosensitiza-tion as treatment for children with newly diagnosed brain stem tumors. Cisplatin was infused over 120 h on weeks 1,3, and 5 during a 6-week radiotherapy course. The following cisplatin dose levels were studied: (1) 50 mg/m²/ 120 h, (2) 75 mg/m²/120 h and (3) 100 mg/m²/120 h. Sixteen of 17 children completed therapy. One child expired after 2 days of treatment secondary to massive intratumoral hemorrhage. At cisplatin dose level 3 (100 mg/m²/ 120 h), grade 2-4 myelosuppression was encountered in 3 of 5 evaluable patients. Otherwise, no other excessive toxicities, including renal and ototox-icity, were noted.

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Current Management of Brain Stem Gliomas

Cited by 24 publications

References 37 publications

Gliomas of the Tectum and Periaqueductal Region of the Mesencephalon

Gliomas of the Tectum and Periaqueductal Region of the Mesencephalon

Brain Stem Gliomas: A Classification System Based on Magnetic Resonance Imaging

Hyperfractionated Irradiation and Concurrent Cisplatin in Brain Stem Tumors: A Pediatric Oncology Group Pilot Study (9139)

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