Favorable outcome with conservative treatment for children with low grade brainstem tumors

Abstract

BackgroundPediatric brainstem tumors (BST) comprise a heterogeneous group of entities. Data regarding treatment options and outcome of BST, specifically brainstem low grade tumors (BSLGT) are limited. In order to better define risk groups and evaluate treatment options for pediatric BST, we performed a comprehensive analysis of all BST patients treated in our hospital during the MRI era.ProceduresWe retrospectively analyzed clinical, imaging, and pathology data at presentation, treatment, and outcome of all BST patients followed at the Hospital for Sick Children in Toronto over the last 25 years.ResultsOf 1,801 children with brain tumors, 223 (12%) had a brainstem primary location. Tumors without pontine involvement were BSLGT in 98.3%, whereas 75% of tumors involving the pons were high grade (P = 0.0001). Patients with BSLGT had 5‐year progression‐free survival (PFS) and overall survival (OS) of 57 ± 3% and 89 ± 5%, respectively. Upfront observation of tumor residual conferred no survival disadvantage with 5‐year PFS and OS of 57 ± 5% and 93 ± 3%, respectively. In the group of patients requiring further treatment, 5‐year PFS and OS were comparable between chemotherapy and radiotherapy with 53 ± 12% and 93 ± 4% and 66 ± 11% and 83 ± 6%, respectively (P = 0.26 and 0.3, respectively).ConclusionBST without pontine involvement are almost invariably BSLGT. Children with BSLGT have an excellent outcome even with careful initial observation. No clear benefit was observed for radiotherapy over chemotherapy when adjuvant treatment was needed. A conservative approach may be warranted for children with non‐pontine brainstem lesions. Pediatr Blood Cancer 2012; 58: 556–560. © 2011 Wiley Periodicals, Inc.

Clinical characteristics and modality of surgical treatment of pediatric neuroepithelial tumors

“…There is no statistically difference in the age of patient in relation to tumor grade. These results are the same as in the literature (15)(16)(17)(18)(19)(20)(21).…”

Radiation Therapy and Nimotuzumab in Children and Adolescents with Brainstem Gliomas: A 5-Year Institutional Experience

“…Pontine localization was found to be a negative prognostic factor. 5 Two more recent studies did not demonstrate similar findings; 25,26 these studies included adult patients, possibly confounding results. In our series, we found pontine infiltration in all patients.…”

“…1,3,5,12,[28][29][30][31][32][33][34] In a previous case series of patients treated only with RT during the period 1992-2008 in the same Institution (National Oncology and Radiobiology Institute, in Havana), median survival time was 10.0 months and the survival rate at 2 years was 15%. We know that the use of retrospective case series as control groups have limitations, but there are facts that are relevant: all cases were irradiated in the same Institution, so there could not exist center-effects that could bias patient groups.…”

“…[1][2][3]5,12,21 Radiation dose escalation increases toxicity but does not improve outcome; neither chemotherapy nor hypofractionation 4,21-24 have improved therapeutic ratio.…”

“…Radiation treatment response rates show low degrees of efficacy, with short-term responses and a median overall survival less than one year; [2][3][4][5][6][7][8] Diffusely infiltrating pontine glio-mas must be distinguished from other subsets of diffuse intrinsic pontinegliomas, such as focal tumors, which are described with better prognosis and longer term survival.…”