UKCCSG study of accelerated radiotherapy for pediatric brain stem gliomas

Lewis, Joanne; Lucraft, H. H.; Gholkar, A

doi:10.1016/s0360-3016(97)00134-x

Cited by 53 publications

(26 citation statements)

References 16 publications

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“…While there is some evidence that chemotherapy is beneficial for opticohypothalamic low-grade gliomas [31, 32, 33, 34, 35], no data exist with regard to similar tumors located in the brainstem. Overall, our data further support previous reports [36, 37, 38, 39]on the beneficial aspects of adjuvant radiotherapy and show no role for additional chemotherapy in the management of patients with diffuse gliomas.…”

Section: Discussionsupporting

confidence: 92%

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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Section: Discussionsupporting

confidence: 92%

Surgical Outcome following Resection of Contrast-Enhanced Pediatric Brainstem Gliomas

et al. 2003

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“…In this cohort, the response of 12 patients was: 0/3/ 4/5 for complete response/partial response/stable disease/progressive disease. When comparing this to literature data from other populations, there does not appear to be an improvement (Packer et al, 1994;Lewis et al, 1997). Since survival times were not prolonged either (Figure 1), these data suggest that the oral chemotherapy with TRO/VP16 did not add to the antitumour effect of radiotherapy.…”

Section: Discussionsupporting

confidence: 53%

“…Increasing the intensity of radiotherapy by hyperfractionation (Packer et al, 1994, and acceleration (Lewis et al, 1997) did not increase the survival further and the sequelae suggest caution with this approach (Freeman et al, 1996). Chemotherapy did not add to the therapeutical success of radiation treatment.…”

mentioning

confidence: 96%

Treatment of paediatric pontine glioma with oral trophosphamide and etoposide

Wolff¹,

Westphal²,

Mölenkamp

et al. 2002

Br J Cancer

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To evaluate the overall survival of paediatric patients with pontine gliomas treated with oral trophosphamide and etoposide. Patients between 3 and 17 years of age with either typical diffuse pontine glioma on MRI or histologically proven anaplastic astrocytoma/glioblastoma multiforme located in the pons, were eligible. Treatment consisted of oral trophosphamide 100 mg m 72 day 71 combined with oral etoposide at 25 mg m 72 day 71 starting simultaneously with conventional radiation. Twenty patients were enrolled (median age 6 years, male : female=9 : 11). Surgical procedures included: no surgery: five, open biopsy: three, stereotactic biopsy: six, partial resection: three, and sub-total resection: three. Histological diagnoses included pilocytic astrocytoma: one, astrocytoma with no other specification: three, anaplastic astrocytoma: three, glioblastoma multiforme: eight, no histology: five. The most frequent side effects were haematologic and gastrointestinal. There was no toxic death. The response to combined treatment in 12 evaluable patients was: complete response: 0, partial response: three, stable disease: four, and progressive disease: five. All tumours progressed locally and all patients died. The overall median survival was 8 months. The overall survival rates at 1 and 4 years were: 0.4 and 0.05 respectively. This was not different from a control group of patients documented in the same population. Oral trophosphamide in combination with etoposide did not improve survival of pontine glioma patients. The treatment was well tolerated and should be evaluated for more chemoresponsive paediatric malignancies.

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“…58,67 Moreover, toxicity is a source of major concern because intratumoral necrosis, steroid dependency, and other chronic factors are frequent. As a result, different collaborative efforts have been investigated to determine the efficacy of chemotherapy for these tumors.…”

mentioning

confidence: 99%

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

Frazier¹,

Lee²,

Thomale

et al. 2009

PED

126

107

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Diffuse intrinsic pontine gliomas constitute ~ 60–75% of tumors found within the pediatric brainstem. These malignant lesions present with rapidly progressive symptoms such as cranial nerve, long tract, or cerebellar dysfunctions. Magnetic resonance imaging is usually sufficient to establish the diagnosis and obviates the need for surgical biopsy in most cases. The prognosis of the disease is dismal, and the median survival is < 12 months. Resection is not a viable option. Standard therapy involves radiotherapy, which produces transient neurological improvement with a progression-free survival benefit, but provides no improvement in overall survival. Clinical trials have been conducted to assess the efficacy of chemotherapeutic and biological agents in the treatment of diffuse pontine gliomas. In this review, the authors discuss recent studies in which systemic therapy was administered prior to, concomitantly with, or after radiotherapy. For future perspective, the discussion includes a rationale for stereotactic biopsies as well as possible therapeutic options of local chemotherapy in these lesions.

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UKCCSG study of accelerated radiotherapy for pediatric brain stem gliomas

Cited by 53 publications

References 16 publications

Surgical Outcome following Resection of Contrast-Enhanced Pediatric Brainstem Gliomas

Surgical Outcome following Resection of Contrast-Enhanced Pediatric Brainstem Gliomas

Treatment of paediatric pontine glioma with oral trophosphamide and etoposide

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

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