Malignant brainstem tumors in children, excluding diffuse intrinsic pontine gliomas

Paul Klimo, Cody L. Nesvick, Alberto Broniscer, Brent A. Orr, Asim Choudhri

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective Malignant tumors of the brainstem, excluding classic diffuse intrinsic pontine gliomas (DIPGs), are a very rare, heterogeneous group of neoplasms that have been infrequently described in the literature. In this paper, the authors present their experiences with treating these unique cancers. Methods A retrospective chart review was conducted to identify eligible cases over a 15-year period. All tumors involving the pons were, by consensus, felt not to be DIPGs based on their neuroimaging features. Demographic information, pathological specimens, neuroimaging characteristics, surgical and nonsurgical management plans, and survival data were gathered for analysis. reSultS Between January 2000 and December 2014, 29 patients were identified. The mean age at diagnosis was 8.4 years (range 2 months to 25 years), and 17 (59%) patients were male. The most common presenting signs and symptoms were cranial neuropathies (n = 24; 83%), hemiparesis (n = 12; 41%), and ataxia or gait disturbance (n = 10; 34%). There were 18 glial and 11 embryonal tumors. Of the glial tumors, 5 were radiation-induced and 1 was a malignant transformation of a previously known low-grade tumor. Surgical intervention consisted of biopsy alone in 12 patients and some degree of resection in another 15 patients. Two tumors were diagnosed postmortem. The median overall survival for all patients was 196 days (range 15 to 3999 days). There are currently 5 (17%) patients who are still alive: 1 with an anaplastic astrocytoma and the remaining with embryonal tumors. Conclusions In general, malignant non-DIPG tumors of the brainstem carry a poor prognosis. However, maximal cytoreductive surgery may be an option for select patients with focal tumors. Long-term survival is possible in patients with nonmetastatic embryonal tumors after multimodal treatment, most importantly maximal resection.

Original languageEnglish (US)
Pages (from-to)57-65
Number of pages9
JournalJournal of Neurosurgery: Pediatrics
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2016

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Brain Stem Neoplasms
Glioma
Neoplasms
Neuroimaging
Neuroglia
Survival
Gait Ataxia
Cranial Nerve Diseases
Combined Modality Therapy
Pons
Astrocytoma
Paresis
Brain Stem
Signs and Symptoms
Demography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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Malignant brainstem tumors in children, excluding diffuse intrinsic pontine gliomas. / Klimo, Paul; Nesvick, Cody L.; Broniscer, Alberto; Orr, Brent A.; Choudhri, Asim.

In: Journal of Neurosurgery: Pediatrics, Vol. 17, No. 1, 01.01.2016, p. 57-65.

Research output: Contribution to journalArticle

Klimo, Paul ; Nesvick, Cody L. ; Broniscer, Alberto ; Orr, Brent A. ; Choudhri, Asim. / Malignant brainstem tumors in children, excluding diffuse intrinsic pontine gliomas. In: Journal of Neurosurgery: Pediatrics. 2016 ; Vol. 17, No. 1. pp. 57-65.
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abstract = "Objective Malignant tumors of the brainstem, excluding classic diffuse intrinsic pontine gliomas (DIPGs), are a very rare, heterogeneous group of neoplasms that have been infrequently described in the literature. In this paper, the authors present their experiences with treating these unique cancers. Methods A retrospective chart review was conducted to identify eligible cases over a 15-year period. All tumors involving the pons were, by consensus, felt not to be DIPGs based on their neuroimaging features. Demographic information, pathological specimens, neuroimaging characteristics, surgical and nonsurgical management plans, and survival data were gathered for analysis. reSultS Between January 2000 and December 2014, 29 patients were identified. The mean age at diagnosis was 8.4 years (range 2 months to 25 years), and 17 (59{\%}) patients were male. The most common presenting signs and symptoms were cranial neuropathies (n = 24; 83{\%}), hemiparesis (n = 12; 41{\%}), and ataxia or gait disturbance (n = 10; 34{\%}). There were 18 glial and 11 embryonal tumors. Of the glial tumors, 5 were radiation-induced and 1 was a malignant transformation of a previously known low-grade tumor. Surgical intervention consisted of biopsy alone in 12 patients and some degree of resection in another 15 patients. Two tumors were diagnosed postmortem. The median overall survival for all patients was 196 days (range 15 to 3999 days). There are currently 5 (17{\%}) patients who are still alive: 1 with an anaplastic astrocytoma and the remaining with embryonal tumors. Conclusions In general, malignant non-DIPG tumors of the brainstem carry a poor prognosis. However, maximal cytoreductive surgery may be an option for select patients with focal tumors. Long-term survival is possible in patients with nonmetastatic embryonal tumors after multimodal treatment, most importantly maximal resection.",
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