Survival and functional outcome of children with hypothalamic/chiasmatic tumors

Fouladi, Maryam; Wallace, Dana; Langston, J. William; Mulhern, Raymond K.; Rose, Susan R.; Gajjar, Amar; Sanford, Robert A.; Merchant, Thomas E.; Jenkins, Jesse J.; Kun, Larry E.; Heideman, Richard L.

doi:10.1002/cncr.11119

Cited by 112 publications

(101 citation statements)

References 35 publications

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“…Similar outcomes were reported by other authors [23,24]. Furthermore, Fouladi et al [25] summarized similar favorable results of observation in optic pathway glioma. Many physicians consider immediate treatment (radiation most often) because of the risk of neurological deficit associated with progression.…”

Section: Discussionsupporting

confidence: 83%

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

Fried¹,

Hawkins²,

Scheinemann³

et al. 2011

Pediatric Blood & Cancer

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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.

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Section: Discussionsupporting

confidence: 83%

“…Studies summarizing outcome of low grade glioma patients receiving adjuvant therapy in other locations report 12-78% 5-year EFS following chemotherapy and 63-87% 3-and 5-year EFS, respectively, following radiotherapy [25][26][27]. Tumors included in these studies involve the optic pathway/hypothalamus in most cases.…”

Section: Discussionmentioning

confidence: 99%

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

Fried¹,

Hawkins²,

Scheinemann³

et al. 2011

Pediatric Blood & Cancer

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“…adjuvant treatment was chemotherapy, and to evaluate the effects of salvage treatment with radiotherapy. Although these encouraging results need to be confirmed in future multicentre studies, one can consider that the goal of improving the intellectual outcome by a chemotherapy-first study compared to irradiation (Cappelli et al, 1998;Fouladi et al, 2003) is achievable.…”

Section: Discussionmentioning

confidence: 95%

Neuropsychological outcome in children with optic pathway tumours when first-line treatment is chemotherapy

et al. 2003

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Standard treatment of optic pathways gliomas consists of radiotherapy and surgery when feasible. Owing to the toxicity of irradiation, chemotherapy has emerged as an interesting therapeutic option, especially in young children. This study describes the neuropsychological profile of 27 children (aged between 1.5 and 15.7 years) with optic pathways gliomas treated with chemotherapy as first-line treatment. Eight of them also received radiotherapy as salvage treatment. Eight had neurofibromatosis type 1 (NF1). Intellectual outcome was preserved in children treated with chemotherapy only (mean ¼ 107717) compared to children also receiving radiotherapy (mean IQ ¼ 88724) or children having NF1 and treated with chemotherapy (mean IQ ¼ 80713). Scores for abstract reasoning, mental arithmetic, chessboard/coding, perception, judgement of line orientation were lower in children irradiated than in those treated only by chemotherapy. Children with Nf1 showed subnormal IQ scores with marked impairment of shortand long-term memory. With respect to long-term neuropsychological outcome, our study shows that a chemotherapy-first strategy can preserve the intellectual outcome of these patients either by avoiding the need of radiotherapy or by delaying its use as much as possible.

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“…Primary resec5on + iMRI (10) 2nd look surgery (7) Second look surgery volume resected (27 Discussion:…”

Section: Figure 2 -Tumour Resection Volumes Expressed As a Percentagementioning

confidence: 99%

“…Histologically, OPHGs are nearly always low-grade tumours, with pilocystic astrocytomas (WHO grade I) accounting for the majority, along with a proportion of pilomyxoid astrocytomas (WHO grade II) [5,7,9,11,17,22,30]. A strong association with Neurofibromatosis Type 1 (NF1) is observed, which tends to correlate with a more benign course [6,10,11,13,17,[24][25]28,34].…”

Section: Introductionmentioning

confidence: 99%

The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children

et al. 2015

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Survival and functional outcome of children with hypothalamic/chiasmatic tumors

Cited by 112 publications

References 35 publications

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

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

Neuropsychological outcome in children with optic pathway tumours when first-line treatment is chemotherapy

The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children

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