Long-term survival outcomes of pineal region gliomas

Abstract

Purpose Surgical series of pineal region gliomas are rarely available. Whereas it is a general assumption that the extent of surgical resection correlates with survival outcomes of intracranial gliomas; the impact of the microsurgical resection on the long-term outcomes of pineal gliomas has been questioned. We present a surgical series of pineal region gliomas with focus on the survival outcome analysis. Methods 17 histologically confirmed pineal region glioma patients classified as diffuse and non-diffuse gliomas were retrospectively analyzed. A detailed description of the series was followed by regression models to identify predictors of clinical outcomes. Uni- a multivariate survival analysis was performed to determine independent predictors of mortality. Results Although the number of treated patients was small, only WHO grade histopathology remained significant (p = 0.02) after multivariate survival analysis with extent of resection, age, tumor volume, and preoperative functional status. The extent of the surgical resection did not correlate with the disease survival rates of non-diffuse (p = 1), diffuse (p = 0.2), nor all gliomas (p = 0.6). 15 of 17 patients underwent gross total (nine patients) or subtotal resection. The preoperative functional status of the patients showed overall improvement on the immediate (p < 0.001) and long-term (p = 0.03) follow-up after 106 (3 – 324) months. Conclusion The extent of the surgical resection does not seem to significantly impact on the survival outcomes of pineal region gliomas. Thus, genotype and molecular features may essentially affect the outcome. Further research on the field is required. Electronic supplementary material The online version of this article (10.1007/s11060-020-03571-z) contains supplementary material, which is available to authorized users.

Pineal Region Gliomas: A Systematic Review of Clinical Features and Treatment Outcomes

“…While HGG tended to manifest with heterogeneous enhancement in the pineal region and sometimes infiltrated the surrounding structure, LGG presented well-demarcated mass lesions with minimal contrast enhancement. The median tumor size was 3.8 cm, presenting comparable results to pineal region meningiomas ( 15 , 32 ). This is likely due to the confined, small space of the pineal region, with an expansion of the tumor resulting in clinical symptoms.…”

“…Of these, 144 papers did not meet inclusion criteria and were subsequently excluded. Twelve articles were included in this systematic review, all categorized as level IV evidence (Table I and Table II) (4,15,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

“…Our results show a variety of reported radiological features among different types of gliomas. While HGG tended to manifest with heterogeneous enhancement in the pineal region and sometimes infiltrated the surrounding structure, LGG presented well-demarcated mass lesions with (15,32). This is likely due to the confined, small space of the pineal region, with an expansion of the tumor resulting in clinical symptoms.…”

“…Although it is a general assumption that the extent of resection and chemoradiotherapy correlate with survival rate, only a handful of case reports and series have studied these questions (4,(15)(16)(17). This study reviews the current literature regarding the clinical management of pineal region gliomas, focusing on clinical characteristics, treatment strategies, and survival outcomes.…”

Case Report: Identification of Multiple TERT and FGFR2 Gene Fusions in a Pineal Region Glioblastoma Case

“…As pineal region glioma is rare, its biological behavior, molecular pathology, and therapeutic strategy were not well characterized. Complete surgical resection of pineal region tumors correlated with favorable survival; however, the outcome of pineal region high-grade gliomas seemed to be independent of the extent of surgical resection ( 11 ). In the revised 2016 WHO Classification of Tumors of the CNS, H3K27M-mutant diffuse midline glioma, arising in the thalamus, pons, and spinal cord, was classified as a WHO grade IV glioma.…”