Abstract
Background
Diffuse brainstem tumors in children are rare and its treatment is controversial. Although radiotherapy (RT) used to be the treatment of choice, results remained unsatisfactory. The association of RT with other therapies is common, but lacks scientific data regarding its efficacy. Comparison of results of irradiation alone versus combined treatment modalities is crucial in improving survival.
Methods
The authors reviewed twenty-four patients with diffuse brainstem tumors, with mean age of 7 years, treated from December 90 to November 99, at the University of Sao Paulo, Brazil. These patients were subdivided in four groups according to the treatment option at the onset of symptoms. Four patients were treated with radiation alone (total dose of 50 Gy to 62.4 Gy), 6 patients with chemotherapy and radiation, 8 with tamoxifen and radiation and 6 with tamoxifen, radiation and chemotherapy. The results of the different groups were them compared.
Findings
Clinical response was observed in 83.3% of our children, briefly followed by progressive disease. Mean survival was 17 months with no statistically significant differences among the groups. Four patients were alive at the end of the study, with a mean survival of 32.4 months, all of them received combined therapy, but with no statistically significant differences.
Conclusions
Neither the association of radiation therapy with chemotherapy, tamoxifen nor both have showed survival improvement. The prognosis of these patients remains very poor and only investigational trials would justify a highly aggressive approach.
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References
Gurney JG, Davis S, Severson RK, et al. Trends in cancer incidence among children in U.S. Cancer. 1996, p. 552–41.
Barkovich AJ, Krischer J, Kun LE. Brain stem gliomas: A classification system based on magnetic resonance imaging. Pediatr Neurosurg. 1990;16:73–83.
Vandertop WP, Hoffman HJ, Drake JM, et al. Focal midbrain tumors in children. Neurosurgery. 1992;31:186–94.
Greenberger JS, Cassady JR, Levene MB. Radiation therapy of thalamic, midbrain, and brain stem gliomas. Radiology. 1977; 122:463–8.
Edwards MSB, Prados M. Current management of brain stem gliomas. Pediatr Neurosci. 1987;13:509–15.
Albright AL, Guthkelch AN, Packer RJ, et al. Prognostic factors in pediatric brain stem gliomas. J. Neurosurg. 1986;65:751–5.
Albright AL, Packer RJ, Zimmerman R, et al. MR scans may replace biopsy in the diagnosis of brain stem gliomas: A report from the Children's Cancer Group. Neurosurgery. 1993;53:1026–9.
Hibi T, Shitara N, Genka S, et al. Radiotherapy for pediatric brain stem glioma: radiation dose, response, and survival. Neurosurgery. 1992;31:643–50.
Langmoen A, Lundar T, Storn-Mathisen I, et al. Management of pediatric brain stem gliomas. Childs Nerv Syst. 1991;7:13–5.
Mandell LR, Kadota R, Freeman C, et al. There is no role for hyperfractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brain stem tumors: results of a Pediatric Oncology Group phase III trial comparing conventional vs hyperfractionated radiotherapy. Int J Radiat Biol Phys. 1999;43:959–64.
Benesch M, Lackner H, Moser A, et al. Outcome and long-term side effects after synchronous radiochemotherapy for childhood brain stem gliomas. Pediatr Neurosurg. 2001;35:173–80.
Statistical Package for Social Science-Systat. Version 10.0 SPSS Inc; 2000.
Guiney MJ, Smith JG, Hughes P, et al. Contemporary management of adult and pediatric brain stem gliomas. Int. J Radiat Oncol Biol Phys. 1993;25:235–41.
Rubin G, Michowitz S, Horev G, et al. Pediatric brain stem gliomas: an update. Childs Nerv Syst. 1998;14:4–5.
Shrieve DC, Wara WM, Edwards MS, et al. Hyperfractionated radiation therapy for gliomas of the brain stem in children and in adults. Int. J Radiat Oncol Biol Phys. 1992;24:599–610.
Farmer JP, Montes JL, Freeman CR, et al. Brain stem Gliomas. A 10-year institutional review. Pediatr Neurosurg. 2001; 34:206–14.
Broniscer A, Leite CC, Lanchote VL, et al. Radiation therapy and high-dose TMX in the treatment of patients with brain stem gliomas: results of a Brazilian cooperative study. J Clin Oncol. 2000;18:1246–53.
Bouffet E, Raquin M, Doz F, et al. Radiotherapy followed by high dose busulfan and thiotepa: a prospective assessment of high dose chemotherapy in children with diffuse pontine glioma. Cancer. 2000;88:685–92.
Packer RJ, Prados M, Phillips P, et al. Treatment of children with newly diagnosed brain stem gliomas with intravenous recombinant beta-interferon and hyperfractionated radiation therapy: a childrens cancer group phase I/II study. Cancer. 1996; 77:2150–6.
Lashoford LS, Thiesse P, Jouvet A, et al. Temozolomide in malignant gliomas of childhood: a United Kingdom Children's Cancer Study Group and French Society for Pediatric Oncology Intergroup Study. J. Clin Oncol. 2002;20:4684–91.
Kuo DJ, Weiner HL, Wisoff J, et al. Temozolomide is active in childhood, progressive, unresectable, low-grade gliomas. J Pediatr Hematol Oncol 2005;25:372–8.
Verschuur AC, Grill J, Lelouch-Tubiana A, et al. Temozolomide in paediatric highgrade glioma: a key for combination therapy? Br J Cancer 2004;91:425–9.
Broniscer A, Iacono L, Chintagumpala M, et al., Role of temozolomide after radiotherapy for newly diagnosed diffuse brainstem glioma in children: results of a multiinstitutional study (SJHG-98). Cancer. 2005;103:153–9.
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de Aquino Gorayeb, M.M., Aisen, S., Nadalin, W. et al. Treatment of childhood diffuse brain stem tumors: comparison of results in different treatment modalities. Clin Transl Oncol 8, 45–49 (2006). https://doi.org/10.1007/s12094-006-0094-9
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DOI: https://doi.org/10.1007/s12094-006-0094-9