Diffuse brainstem glioma: prognostic factors (original) (raw)
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Brainstem gliomas in adults: prognostic factors and classification
Brain, 2001
In contrast to childhood brainstem gliomas, adult brainstem gliomas are rare and poorly understood. The charts of 48 adults suffering from brainstem glioma were reviewed in order to determine prognostic factors, evaluate the effect of treatment and propose a classification of these tumours. Mean age at onset was 34 years (range 16-70 years). The main presenting symptoms were gait disturbance (61%), headache (44%), weakness of the limbs (42%) and diplopia (40%). Four patterns were identified on MRI, representing nonenhancing, diffusely infiltrative tumours (50%), contrastenhancing localized masses (31%), isolated tectal tumours (8%) and other patterns (11%). Treatment consisted of partial resection (8%), radiotherapy (94%) and chemotherapy (56%). Overall median survival was 5.4 years. On univariate analysis, the following favourable prognostic factors were identified (P < 0.01): age of onset <40 years, duration of symptoms before diagnosis >3 months, Karnofski performance status >70, low-grade histology, absence of contrast enhancement and 'necrosis' on MRI. On multivariate analysis, the duration of symptoms, the appearance of 'necrosis' on MRI and the histological grade of the tumour remained significant and independent prognostic factors (P < 0.05). Eighty-five percent of the tumours could be classified into one of the following three groups on the basis of clinical, radiological Abbreviations: CI ϭ confidence interval; NF1 ϭ neurofibromatosis type 1
Prognostic factors in adult brainstem gliomas: a multicenter, retrospective analysis of 101 cases
Journal of Neuro-Oncology, 2008
Background Adult brainstem gliomas (BSG) are uncommon and poorly understood with respect to prognostic factors. We retrospectively evaluated the clinical, radiographic, histologic, and treatment features from 101 adults with presumed or biopsy proven BSG to determine prognostic factors. Patients and Methods We reviewed the records of patients diagnosed from 1987-2005. We used Cox proportional hazard models to determine prognostic factors. Results These 50 male and 51 female patients ranged in age from 18 to 79 years at diagnosis (median 36 years) with follow-ups from 1 to 261 months (median 47 months). The overall survival for all patients at 5 and 10 years was 58% and 41%, respectively, with a median survival of 85 months (range 1-228). Out of 24 candidate prognosis factors, we selected seven covariates for proportional hazards model by Lasso procedure: age of diagnosis, ethnicity, need for corticosteroids, tumor grade, dysphagia, tumor location, and karnofsky performance status (KPS). Univariate analysis showed that these seven factors are significantly associated with survival. Multivariate analysis showed that four covariates significantly increased hazard for survival: ethnicity, tumor location, age of diagnosis, and tumor grade. Conclusions In this study, we identified four prognostic factors that were significantly associated with survival in adults with BSGs. Overall, these patients have a better prognosis than children with BSGs reported in the literature. These results call for larger prospective studies to fully assess the importance of these factors in the clinical setting and to help stratify patients in future clinical studies.
Neuro-Oncology, 2011
We report MRI findings from 2 pediatric clinical trials of diffuse intrinsic brainstem glioma (BSG) incorporating concurrent radiation therapy (RT) with molecularly targeted agents (gefitinib and tipifarnib). We determined associations of MRI variables with progression-free survival and overall survival and investigated effects of treatment on these variables. MRI (including diffusion and perfusion) was done before treatment, every 8 weeks (first year), every 12 weeks (thereafter), and at the end of treatment or disease progression. Reduced tumor volume (P < .0001) and tumor diffusion values (P < .0001) were apparent on the first post-RT/drug studies. Decreases in tumor volume correlated with pre-RT volume (P < .0001) and pre-RT diffusion values (P < .0001); larger decreases were noted for tumors with higher volumes and diffusion values. Patients with larger pre-RT tumors had longer progression-free survival (P < .0001). Patients with ≥25% decrease in tumor volume and diffusion values after RT had longer progressionfree survival (P 5 .028) and overall survival (P 5 .0009). Enhancement at baseline and over time was significantly associated with shorter survival. Tumor diffusion values with baseline enhancement were significantly lower than those without (P 5 .0002). RT of BSG is associated with decreased tumor volume and intralesional diffusion values; patients with ≥25% decrease in values post-RT had relatively longer survival intervals, apparently providing an early imaging-based surrogate for relative outcomes. Patients with larger tumors and greater decreases in tumor volume and diffusion values had longer survival intervals. Tumor enhancement was associated with shorter survival, lower tumor diffusion values (increased cellularity), and a smaller drop in diffusion values after RT (P 5 .006). These associations justify continued investigation in other large clinical trials of brainstem glioma patients.
American Journal of Neuroradiology, 2014
BACKGROUND AND PURPOSE: Diffuse gliomas are classified as grades II-IV on the basis of histologic features, with prognosis determined mainly by clinical factors and histologic grade supported by molecular markers. Our aim was to evaluate, in patients with diffuse gliomas, the relationship of relative CBV and ADC values to overall survival. In addition, we also propose a prognostic model based on preoperative MR imaging findings that predicts survival independent of histopathology. MATERIALS AND METHODS: We conducted a retrospective analysis of the preoperative diffusion and perfusion MR imaging in 126 histologically confirmed diffuse gliomas. Median relative CBV and ADC values were selected for quantitative analysis. Survival univariate analysis was made by constructing survival curves by using the Kaplan-Meier method and comparing subgroups by log-rank probability tests. A Cox regression model was made for multivariate analysis. RESULTS: The study included 126 diffuse gliomas (median follow-up of 14.5 months). ADC and relative CBV values had a significant influence on overall survival. Median overall survival for patients with ADC Ͻ 0.799 ϫ 10 Ϫ3 mm 2 /s was Ͻ1 year. Multivariate analysis revealed that patient age, relative CBV, and ADC values were associated with survival independent of pathology. The preoperative model provides greater ability to predict survival than that obtained by histologic grade alone. CONCLUSIONS: ADC values had a better correlation with overall survival than relative CBV values. A preoperative prognostic model based on patient age, relative CBV, and ADC values predicted overall survival of patients with diffuse gliomas independent of pathology. This preoperative model provides a more accurate predictor of survival than histologic grade alone. ABBREVIATION: rCBV ϭ relative cerebral blood volume D iffuse gliomas are the second most common primary CNS neoplasms, behind meningiomas, and account for roughly 80% of primary malignant brain tumors. 1-3 Diffuse gliomas are a heterogeneous group of neoplasms classified according to the World Health Organization system as grades II-IV on the basis of histologic features, including cell density nuclear atypia, mitotic activity, endothelial proliferation, and
Prognosis of gliomas in the 1970s and today
Neurosurgical FOCUS, 2005
The benefit of the current strategy for diagnosis (magnetic resonance [MR] imaging) and treatment (surgery, chemotherapy, radiotherapy) of gliomas, in contrast to the standard treatment in use before MR imaging and the micro-surgical era, has not yet been determined. A retrospective statistical analysis was performed for all patients with glioma who underwent surgery at a single institution between 1965 and 1974 (Group I, 88 patients) or 1986 and 1995 (Group II, 249 patients). There were no major differences in symptomatology, tumor localization, and number of surgical procedures. The mean time until tumor diagnosis was significantly shorter in Group II (Group I, 48 weeks; Group II, 19.5 weeks). Also, the mean time from initial symptoms to surgery was significantly shorter for high-grade gliomas in Group II (Group I, 16.3 weeks; Group II, 11.7 weeks). For high- as well as low-grade gliomas, there was a clear reduction of the perioperative morbidity and mortality rates in Group II. N...
Brainstem glioma clinical features and treatment outcomes: a case series
International Journal of Scientific Reports
A diverse category of gliomas that mostly affect youngsters are known as brainstem gliomas (BGs). The diffuse intrinsic pontine glioma (DIPG), exophytic medullary glioma, and tectal glioma can be divided into categories based on architecture and clinical behaviour. The most frequent BG is DIPG. The median age at start is 6.5 years, and the median survival is less than a year. The fact that adults with DIPG live longer suggests that their tumours are less aggressive and have physiologically distinct origins than those in children. Patients may appear with one or more of the following symptoms: ataxia, long tract signs, or malfunction of the cranial nerves. The majority of the pons is occupied by an infiltrative lesion on magnetic resonance imaging, and contrast enhancement is typically not noticeable. Fractionated radiation is the norm in medicine.
Surgical treatment and prognosis of adult patients with brainstem gliomas
Neurologia i Neurochirurgia Polska, 2018
Brainstem gliomas account for only 1-2% of all adult gliomas and are characterized by poor prognosis. In particular, unfavourable prognosis is related to patients with enhancing high-Grades III and IV gliomas (WHO classification) and diffuse brainstem gliomas. However, in the latter group the prognosis is better than in children [1-3]. A 5-year survival was reported in 58% of adult patients with diffuse brainstem gliomas, which n e u r o l o g i a i n e u r o c h i r u r g i a p o l s k a 5 2 (2 0 1 8) 6 2 3-6 3 3 a r t i c l e i n f o
Adult brainstem glioma: a multicentre retrospective analysis of 47 Italian patients
Neurological Sciences, 2020
Background and purpose Adult brainstem gliomas are rare primary brain tumours with heterogeneous clinical course. The low frequency of these tumours makes it difficult to achieve high-quality evidence regarding prognostic factors, adequate therapeutic approach and outcome in such patients. Methods In this retrospective study, we analysed clinical, radiological, molecular, prognostic and therapeutic factors in a series of 47 histologically proven adult brainstem gliomas recruited over a 20-year period (1998-2018). Results Twenty-two patients were male, 25 female with median age of 39 years. The tumour involved one brainstem segment in 20 cases and 2 or more segments in 27. Contrast enhancement was reported in 28 cases. Surgical procedures included biopsy in 26 cases and partial/total resection in the remaining 21. Histological diagnosis was of low-grade glioma in 23 patients, high-grade glioma in 22 and non-diagnostic in 2 cases. Data regarding molecular biology were available for 22 patients. Median overall survival was 35 months, in particular 16 months in high-grade glioma and 84 months in low-grade glioma. At univariate analysis, tumour grade was the only factor with a statistically significant impact on survival time (p = 0,003), whereas younger age, better performance status and total/subtotal resection showed a trend to more prolonged survival. This study also confirms safety of biopsy/surgery in adult brainstem glioma patients and shows a clear trend to a more frequent assessment of molecular biology data. Conclusions Further prospective multicentre efforts, and hopefully clinical trials, are necessary to improve outcome in this neglected glioma patient population.