Diffuse brain stem glioma

Cartmill, Maria; Punt, Jonathan

doi:10.1007/s003810050379

Cited by 77 publications

(12 citation statements)

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“…From the available surgical specimens obtained prior to radiation therapy, about 70–90 % of DIPG are anaplastic astrocytoma (WHO grade III) and GBM (WHO grade IV). More grade III tumors were reported than grade IV in the HIT-GBM protocols [14, 15] while earlier reports from other groups had more grade IV than grade III [16, 17]. At late stage of the disease or autopsy, the vast majority of DIPG is high grade and have dissemination within the neuraxis [18].…”

Section: Discussionmentioning

confidence: 99%

B7-H3, a potential therapeutic target, is expressed in diffuse intrinsic pontine glioma

et al. 2012

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Diffuse intrinsic pontine glioma (DIPG) is a brain cancer with a median survival of only 1 year. Lack of molecular characterization of this tumor impedes the development of novel therapies. Membrane protein B7-H3, aka CD276, involved in interactions with host defenses in certain cancers, has been shown to be over-expressed in the majority of malignant neuroectodermal tumors including adult high-grade glioma. Targeting B7-H3 with a monoclonal antibody has demonstrated safety and efficacy in the salvage treatment of stage IV childhood neuroblastoma, another neuroectodermal tumor. It thus stands to reason that B7-H3 might serve as a therapeutic target in DIPG. B7-H3 immunoreactivity was determined in DIPG and non-diffuse brainstem glioma specimens with immunohistochemistry. In addition, B7-H3 mRNA expression was evaluated with microarrays in another set of specimens. All of the nine (100 %) DIPG specimens were shown to be B7-H3 immunoreactive. In the non-diffuse brainstem glioma group, none of the eight WHO grade I specimens showed B7-H3 immunoreactivity and nine of the 24 WHO grade II specimens (37.5 %) showed B7-H3 immunoreactivity. The association between histological grade and B7-H3 immunoreactivity was statistically highly significant. B7-H3 mRNA expression was also significantly higher in DIPG samples than in normal brain and juvenile pilocytic astrocytoma (WHO grade I) specimens. In summary, B7-H3 is over-expressed in DIPG. Given the need for novel treatment in this disease, antibody-based immunotherapy against B7-H3 in DIPG warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

B7-H3, a potential therapeutic target, is expressed in diffuse intrinsic pontine glioma

et al. 2012

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“…Certainly, one possible alternative to open surgical resection is stereotactic biopsy followed by focal radiotherapy/radiosurgery. The feasibility and safety of stereotactic biopsy involving brainstem lesions are well established [23, 24, 25], as is the benefit of radiosurgery for the treatment of brainstem tumors [26, 27, 28, 29, 30]. Nevertheless, our high level of morbidity must be interpreted in the context of preoperative neurologic deficits.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome following Resection of Contrast-Enhanced Pediatric Brainstem Gliomas

et al. 2003

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Background: The role of surgery in the management of gadolinium-enhancing pediatric brainstem lesions on magnetic resonance imaging (MRI) has been a matter of open debate. This clinical series correlates radiological and pathological findings to assess the role of contrast enhancement as an indication for surgery with respect to clinical outcome. Methods: We retrospectively reviewed the charts of all pediatric patients admitted to the Johns Hopkins Hospital with a diagnosis of a brainstem tumor between January 1985 and December 2000. Results: There were a total of 89 patients who met the inclusion criteria. Fifty-seven patients (64.0%) underwent surgical resection while 32 (36%) were treated with radiation and/or chemotherapy. Of the surgical candidates, 57 (100%) had an accompanying MRI scan significant for an enhancing lesion in the midbrain, pons or the medulla. The pathology was consistent with juvenile pilocytic astrocytoma in 30 patients (52.6%) and glioblastoma multiforme in 12 patients (21.1%). The remaining cases consisted of 10 patients (17.5%) with fibrillary astrocytomas, 3 (5.3%) with gangliogliomas, 1 (1.8%) with an oligodendroglioma and 1 (1.8%) with a primitive neuroectodermal tumor. A total of 29 patients had a total surgical resection, 8 a near total resection (>90%), 15 a subtotal resection (50–90%) and 5 a partial resection (<50%). The progression-free survival of all patients was 71.9% at 3 years and 45.6% at 5 years. Conclusions: This case series illustrates that contrast-enhanced MRI has positive prognostic value in the management of pediatric brainstem gliomas. In our study, the majority of enhancing tumors were low grade and amenable to surgical intervention. Consequently, we recommend surgical resection and pathological diagnosis of all enhancing brainstem tumors with adjuvant therapy reserved for recurrent or unresectable cases.

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“…[12] Despite improved brain-stem imaging by magnetic resonance and high-resolution X-ray computerized tomography, preoperative radiological diagnoses prove to be wrong in 10–20% of all cases. [134] It is therefore imperative to have a tissue diagnosis to take appropriate therapeutic measures. [24] Stereotactic biopsy of lesions in the brain stem has been performed since the 1960s.…”

Section: Introductionmentioning

confidence: 99%

“…[24] Stereotactic biopsy of lesions in the brain stem has been performed since the 1960s. [156] We report here a series of 24 patients (14 males, ten females, age range: 6–17 years) who underwent CT-guided stereotactic biopsy for brain stem lesions by the suboccipital transcerebellar route in a semi-sitting position. Presented here is a detailed description of the transcerebellar approach used by the author and the significance and advantages of transcerebellar biopsy in the awake stage.…”

Section: Introductionmentioning

confidence: 99%

Transcerebellar stereotactic biopsy for brainstem lesions in children

Patel

Balamurugan

2009

J Pediatr Neurosci

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Brain stem lesions are pathologically heterogeneous. Pre-operative radiological diagnoses prove to be wrong in 10 to 20% of cases. It is therefore imperative to have a tissue diagnosis for appropriate therapeutic measures. We report a series of 24 patients (14 males, ten females, age range: 6–17 years) CT guided stereotactic biopsy for brain stem lesions approached via the suboccipital transcerebellar route in semi sitting position with principle used to violate only one pial plane with the biopsy probe not entering the ventral surface of the cerebellum. The inclusion and exclusion criteria with detailed material and method are discussed. Histological diagnosis was established in 23 patients (96%) with no procedure-related mortality. Our results indicate that stereotaxic approach to brain-stem lesions provides a high yield of positive histological diagnoses with a low incidence of morbidity. Awake CT-guided stereotactic biopsy via the suboccipital transcerebellar route in a semi-sitting position is a safe, reliable, and effective method for brainstem lesions that can obtain adequate tissue for histological diagnosis, thus providing each patient with the best available treatment.

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Diffuse brain stem glioma

Cited by 77 publications

References 0 publications

B7-H3, a potential therapeutic target, is expressed in diffuse intrinsic pontine glioma

B7-H3, a potential therapeutic target, is expressed in diffuse intrinsic pontine glioma

Surgical Outcome following Resection of Contrast-Enhanced Pediatric Brainstem Gliomas

Transcerebellar stereotactic biopsy for brainstem lesions in children

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