Abstract
Brainstem gliomas in adults are rare tumors, with heterogeneous clinical course; only a few studies in the MRI era describe the features in consistent groups of patients. In this retrospective study, we report clinical features at onset, imaging characteristics and subsequent course in a group of 34 adult patients with either histologically proven or clinico-radiologically diagnosed brainstem gliomas followed at two centers in Northern Italy. Of the patients 18 were male, 14 female, with a median age of 31. In 21 of the patients histology was obtained and in 20 it was informative (2 pilocytic astrocytoma, 9 low-grade astrocytoma, 8 anaplastic astrocytoma and 1 glioblastoma). Contrast enhancement at MRI was present in 14 patients. In all of the 9 patients who were investigated with MR spectroscopy, the Cho/NAA ratio was elevated at diagnosis. In 8 of the patients, an initial watch and wait policy was adopted, while 24 were treated shortly after diagnosis with either radiotherapy alone [4] or radiotherapy and chemotherapy [20] (mostly temozolomide). Only minor radiological responses were observed after treatments; in a significant proportion of patients (9 out of 15) clinical improvement during therapy occurred in the context of radiologically (MRI) stable disease. Grade III or IV myelotoxicity was observed in 6 patients.
After a follow-up ranging from 9 to 180 months, all but 2 patients have progressed and 14 have died (12 for disease progression, 2 for pulmonary embolism). Median overall survival time was of 59 months. Investigation of putative prognostically relevant parameters showed that a short time between disease onset and diagnosis was related to a shorter survival. Compared with literature data, our study confirms the clinical and radiological heterogeneity of adult brainstem gliomas and underscores the need for multicenter trials in order to assess the efficacy of treatments in these tumors.
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Guy G, Jan M, Guegan Y (1989) Les lésions chirurgicales du tronc cerebral. Neurochirurgie 35(Suppl. 1):1–134
Guillamo J-S, Monjour A, Taillandier L, Devaux B, Varlet P, Haie-Meder C, Defer G-L, Maison P, Mazeron J-J, Cornu P, Delattre J-Y for the Association del Neuro-Oncologues d’Expressione Française (ANOCEF) (2001) Brainstem gliomas in adults: prognostic factors and classification. Brain 124:2528–2539
Guillamo J-S, Doz F, Delattre J-Y (2001) Brain stem gliomas. Curr Opin Neurology 14:711–715
MacDonald DR, Cascino TL, Schold SC, Jr. , Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280
Tokuriki Y, Handa H, Yamashita J, Okumura T, Paine JT (1986) Brainstem glioma: an analysis of 85 cases. Acta Neurochir (Wien) 79:67–73
Bricolo A, Turazzi S, Cristofori L, Talacchi A (1991) Direct surgery for brainstem tumors. Acta Neurochir (Suppl. ) (Wien) 53:148–158
Landolfi, JC, Thaler HT, DeAngelis L (1998) Adult brainstem gliomas. Neurology 51:1136–1139
Linstadt DE, Edwards MS, Prados M, Larson DA, Wara WM (1991) Hyperfractionated irradiation for adults with brainstem gliomas. Int J Radiat Oncol Biol Phys 20:757–760
Elgamal EA, Coakham HB (2005) Hemifacial spasm caused by pontine glioma: case report and review of the literature. Neurosurg Rev 28:330–332
Laprie A, Pirkzall A, Haas-Kogan DA, Cha S, Banerjee A, Le TP, Lu Y, Nelson S, McKnight TR (2005) Longitudinal multivoxel MR spectroscopy study of pediatric diffuse brainstem gliomas treated with radiotherapy. Int J Radiat Oncol Biol Phys 62:20–31
Guiney MJ, Smith JG, Hughes P, Yang C, Narayan K (1993) Contemporary management of adult and pediatric brain stem gliomas. Int J Radiat Oncol Biol Phys 25:235–241
Pincus DW, Richter EO, Yachnis AT, Bennett J, Bhatti MT, Smith A (2006) Brainstem stereotactic biopsy sampling in children. J Neurosurg (2 Suppl Pediatrics) 104:108–114
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJB, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross G, Eisenhauer E, Mirimanoff RO for the EORTC brain tumor and radiotherapy groups and the National Cancer Institute of Canada clinical trials group (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New Engl J Med 352:987–996
Broniscer A, Iacono L, Chintagumpala M, Foladi M, Wallace D, Bowers DC, Stewart C, Krasin MJ, Gajjar A (2005) Role of temozolomide after radiotherapy for newly diagnosed diffuse brainstem glioma in children. Results of a multi-institutional study (SJHG-98). Cancer 103:133–139
Donaldson SS, Laningham F, Fisher PG (2006) Advances toward an understanding of brainstem gliomas. J Clin Oncol 24(8):1266–1272
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Salmaggi, A., Fariselli, L., Milanesi, I. et al. Natural history and management of brainstem gliomas in adults. J Neurol 255, 171–177 (2008). https://doi.org/10.1007/s00415-008-0589-0
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DOI: https://doi.org/10.1007/s00415-008-0589-0