Skip to main content
Top
Published in: Child's Nervous System 4/2020

01-04-2020 | Glioma | Original Article

Biopsy in diffuse pontine gliomas: expert neurosurgeon opinion—a survey from the SIOPE brain tumor group

Authors: Sonia Tejada, Kristian Aquilina, John Goodden, Benedetta Pettorini, Conor Mallucci, Marie Lise van Veelen, Ulrich-W. Thomale

Published in: Child's Nervous System | Issue 4/2020

Login to get access

Abstract

Introduction

The prognosis of diffuse intrinsic pontine glioma (DIPG) is poor. The role of biopsy in DIPG remains controversial since the diagnosis may be established with imaging alone. Recent advances in understanding molecular biology and targeting of brain tumors have created a renewed interest in biopsy for DIPG. The Neurosurgery Working Group (NWG) of the SIOP-Europe Brain Tumor Group (BTG) undertook a survey among international pediatric neurosurgeons to define their current perceptions and practice regarding DIPG biopsy.

Methods

The NWG developed a 20-question survey which was emailed to neurosurgeons in the International Society for Pediatric Neurosurgery (ISPN). The questionnaire included questions on diagnosis, indications, and techniques for biopsy, clinical trials, and healthcare infrastructure.

Results

The survey was sent to 202 neurosurgeons and 73 (36%) responded. Consensus of > 75% agreement was reached for 12/20 questions, which included (1) radiological diagnosis of DIPG is sufficient outside a trial, (2) clinical trial–based DIPG biopsy is justified if molecular targets are investigated and may be used for treatment, and (3) morbidity/mortality data must be collected to define the risk:benefit ratio. The remaining 8/20 questions proved controversial and failed to reach consensus.

Conclusions

Routine DIPG biopsy continues to be debated. Most neurosurgeons agreed that DIPG biopsy within a clinical trial should be supported, with the aims of defining the procedure risks, improving understanding of tumor biology, and evaluating new treatment targets. Careful family counseling and consent remain important.
Literature
1.
go back to reference Albright AL, Packer RJ, Zimmerman R, Rorke LB, Boyett J, Hammond GD (1993) Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the children’s cancer group. Neurosurgery 33(6):1026–1030PubMed Albright AL, Packer RJ, Zimmerman R, Rorke LB, Boyett J, Hammond GD (1993) Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the children’s cancer group. Neurosurgery 33(6):1026–1030PubMed
2.
go back to reference Epstein F, Constantini S (1996) Practical decisions in the treatment of pediatric brain stem tumors. Pediatr Neurosurg 24(1):24–34CrossRef Epstein F, Constantini S (1996) Practical decisions in the treatment of pediatric brain stem tumors. Pediatr Neurosurg 24(1):24–34CrossRef
3.
go back to reference Fisher PG, Breiter SN, Carson BS, Wharam MD, Williams JA, Weingart JD, Foer DR, Goldthwaite PT, Tihan T, Burger PC (2000) A clinicopathologic reappraisal of brain stem tumor classification. Identification of pilocystic astrocytoma and fibrillary astrocytoma as distinct entities. Cancer 89(7):1569–1576CrossRef Fisher PG, Breiter SN, Carson BS, Wharam MD, Williams JA, Weingart JD, Foer DR, Goldthwaite PT, Tihan T, Burger PC (2000) A clinicopathologic reappraisal of brain stem tumor classification. Identification of pilocystic astrocytoma and fibrillary astrocytoma as distinct entities. Cancer 89(7):1569–1576CrossRef
4.
go back to reference Frazier JL, Lee J, Thomale UW, Noggle JC, Cohen KJ, Jallo GI (2009) Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies. J Neurosurg Pediatr 3(4):259–269CrossRef Frazier JL, Lee J, Thomale UW, Noggle JC, Cohen KJ, Jallo GI (2009) Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies. J Neurosurg Pediatr 3(4):259–269CrossRef
5.
go back to reference Jansen MH, van Zanten SEV, Aliaga ES, Heymans MW, Warmuth-Metz M, Hargrave D, van der Hoeven EJ, Gidding CE, de Bont ES, Eshghi OS, Reddingius R, Peeters CM, Meeteren AY S-v, Gooskens RH, Granzen B, Paardekooper GM, Janssens GO, Noske DP, Barkhof F, Kramm CM, Vandertop WP, Kaspers GJ, van Vuurden DG (2015) Survival prediction model of children with diffuse intrinsic pontine glioma based on clinical and radiological criteria. Neuro Oncol 17(1):160–166CrossRef Jansen MH, van Zanten SEV, Aliaga ES, Heymans MW, Warmuth-Metz M, Hargrave D, van der Hoeven EJ, Gidding CE, de Bont ES, Eshghi OS, Reddingius R, Peeters CM, Meeteren AY S-v, Gooskens RH, Granzen B, Paardekooper GM, Janssens GO, Noske DP, Barkhof F, Kramm CM, Vandertop WP, Kaspers GJ, van Vuurden DG (2015) Survival prediction model of children with diffuse intrinsic pontine glioma based on clinical and radiological criteria. Neuro Oncol 17(1):160–166CrossRef
6.
go back to reference K.J. Cohen, N. Jabado, and J. Grill, “Neuro-oncology and new biologic insights. Is there a glimmer of hope ?,” vol. 19, no. December, pp. 1025–1034, 2017 K.J. Cohen, N. Jabado, and J. Grill, “Neuro-oncology and new biologic insights. Is there a glimmer of hope ?,” vol. 19, no. December, pp. 1025–1034, 2017
7.
go back to reference Albright AL, Price RA, Guthkelch AN (1983) Brain stem gliomas of children. A clinicopathological study. Cancer 52(12):2313–2319CrossRef Albright AL, Price RA, Guthkelch AN (1983) Brain stem gliomas of children. A clinicopathological study. Cancer 52(12):2313–2319CrossRef
8.
go back to reference Constantini S, Epstein F (1996) Surgical indication and technical considerations in the management of benign brain stem gliomas. J Neuro-Oncol 28(2–3):193–205 Constantini S, Epstein F (1996) Surgical indication and technical considerations in the management of benign brain stem gliomas. J Neuro-Oncol 28(2–3):193–205
9.
go back to reference Grill J, Puget S, Andreiuolo F, Philippe C, MacConaill L, Kieran MW (2012) Critical oncogenic mutations in newly diagnosed pediatric diffuse intrinsic pontine glioma. Pediatr Blood Cancer 58(4):489–491CrossRef Grill J, Puget S, Andreiuolo F, Philippe C, MacConaill L, Kieran MW (2012) Critical oncogenic mutations in newly diagnosed pediatric diffuse intrinsic pontine glioma. Pediatr Blood Cancer 58(4):489–491CrossRef
10.
go back to reference N. Gupta, L.C. Goumnerova, P. Manley, S.N. Chi, D. Neuberg, M. Puligandla, J. Fangusaro, S. Goldman, T. Tomita, T. Alden, A. DiPatri, J.B. Rubin, K. Gauvain, D. Limbrick, J. Leonard, J.R. Geyer, S. Leary, S. Browd, Z. Wang, S. Sood, A. Bendel, M. Nagib, S. Gardner, M.A. Karajannis, D. Harter, K. Ayyanar, W. Gump, D.C. Bowers, B. Weprin, T.J. MacDonald, D. Aguilera, B. Brahma, N.J. Robison, E. Kiehna, M. Krieger, E. Sandler, P. Aldana, Z. Khatib, J. Ragheb, S. Bhatia, S. Mueller, A. Banerjee, A.L. Bredlau, S. Gururangan, H. Fuchs, K.J. Cohen, G. Jallo, K. Dorris, M. Handler, M. Comito, M. Dias, K. Nazemi, L. Baird, J. Murray, N. Lindeman, J.L. Hornick, H. Malkin, C. Sinai, L. Greenspan, K.D. Wright, M. Prados, P. Bandopadhayay, K.L. Ligon, M.W. Kieran, “Neuro-oncology prospective feasibility and safety assessment of surgical biopsy for patients with newly diagnosed diffuse intrinsic pontine glioma,” vol. 20, no. May, pp. 1547–1555, 2018 N. Gupta, L.C. Goumnerova, P. Manley, S.N. Chi, D. Neuberg, M. Puligandla, J. Fangusaro, S. Goldman, T. Tomita, T. Alden, A. DiPatri, J.B. Rubin, K. Gauvain, D. Limbrick, J. Leonard, J.R. Geyer, S. Leary, S. Browd, Z. Wang, S. Sood, A. Bendel, M. Nagib, S. Gardner, M.A. Karajannis, D. Harter, K. Ayyanar, W. Gump, D.C. Bowers, B. Weprin, T.J. MacDonald, D. Aguilera, B. Brahma, N.J. Robison, E. Kiehna, M. Krieger, E. Sandler, P. Aldana, Z. Khatib, J. Ragheb, S. Bhatia, S. Mueller, A. Banerjee, A.L. Bredlau, S. Gururangan, H. Fuchs, K.J. Cohen, G. Jallo, K. Dorris, M. Handler, M. Comito, M. Dias, K. Nazemi, L. Baird, J. Murray, N. Lindeman, J.L. Hornick, H. Malkin, C. Sinai, L. Greenspan, K.D. Wright, M. Prados, P. Bandopadhayay, K.L. Ligon, M.W. Kieran, “Neuro-oncology prospective feasibility and safety assessment of surgical biopsy for patients with newly diagnosed diffuse intrinsic pontine glioma,” vol. 20, no. May, pp. 1547–1555, 2018
11.
go back to reference T. J. MacDonald, “Diffuse intrinsic pontine glioma (DIPG): time to biopsy again?” Pediatr Blood Cancer, vol. 58, no. 4. United States, pp. 487–488, 2012 T. J. MacDonald, “Diffuse intrinsic pontine glioma (DIPG): time to biopsy again?” Pediatr Blood Cancer, vol. 58, no. 4. United States, pp. 487–488, 2012
12.
go back to reference El Khouly FE, Van Zanten SEMV, Santa V, Lopez M (2019) Diagnostics and treatment of diffuse intrinsic pontine glioma: where do we stand? J Neurooncol 145(1):177–184CrossRef El Khouly FE, Van Zanten SEMV, Santa V, Lopez M (2019) Diagnostics and treatment of diffuse intrinsic pontine glioma: where do we stand? J Neurooncol 145(1):177–184CrossRef
13.
go back to reference Puget S, Beccaria K, Blauwblomme T, Roujeau T, James S, Grill J, Zerah M, Varlet P, Sainte-Rose C (2015) Biopsy in a series of 130 pediatric diffuse intrinsic pontine gliomas. Childs Nerv Syst 31(10):1773–1780CrossRef Puget S, Beccaria K, Blauwblomme T, Roujeau T, James S, Grill J, Zerah M, Varlet P, Sainte-Rose C (2015) Biopsy in a series of 130 pediatric diffuse intrinsic pontine gliomas. Childs Nerv Syst 31(10):1773–1780CrossRef
14.
go back to reference Chheda ZS, Kohanbash G, Okada K, Jahan N, Sidney J, Pecoraro M, Yang X, Carrera DA, Downey KM, Shrivastav S, Liu S, Lin Y, Lagisetti C, Chuntova P, Watchmaker PB, Mueller S, Pollack IF, Rajalingam R, Carcaboso AM, Mann M, Sette A, Garcia KC, Hou Y, Okada H (Jan. 2018) Novel and shared neoantigen derived from histone 3 variant H3.3K27M mutation for glioma T cell therapy. J Exp Med 215(1):141–157CrossRef Chheda ZS, Kohanbash G, Okada K, Jahan N, Sidney J, Pecoraro M, Yang X, Carrera DA, Downey KM, Shrivastav S, Liu S, Lin Y, Lagisetti C, Chuntova P, Watchmaker PB, Mueller S, Pollack IF, Rajalingam R, Carcaboso AM, Mann M, Sette A, Garcia KC, Hou Y, Okada H (Jan. 2018) Novel and shared neoantigen derived from histone 3 variant H3.3K27M mutation for glioma T cell therapy. J Exp Med 215(1):141–157CrossRef
15.
go back to reference Castel D, Barret E, Picot S, Plessier A, Le Dret L, Nysom K, Huybrechts S, Capolino P, Le Deley MC, Vassal G, Puget S, Varlet P, Grill J, Debily MA (2017) DIPG-21. Genomic landscape of the first 100 tumors registered in the biological medicine for DIPG eradication (BIOMEDE) trial. Neuro Oncol 19(suppl_4):iv9–iv9CrossRef Castel D, Barret E, Picot S, Plessier A, Le Dret L, Nysom K, Huybrechts S, Capolino P, Le Deley MC, Vassal G, Puget S, Varlet P, Grill J, Debily MA (2017) DIPG-21. Genomic landscape of the first 100 tumors registered in the biological medicine for DIPG eradication (BIOMEDE) trial. Neuro Oncol 19(suppl_4):iv9–iv9CrossRef
16.
go back to reference Tejada S, Alonso M, Patino A, Fueyo J, Gomez-Manzano C, Diez-Valle R (2017) Phase I trial of DNX-2401 for diffuse intrinsic pontine glioma newly diagnosed in pediatric patients. Neurosurgery Tejada S, Alonso M, Patino A, Fueyo J, Gomez-Manzano C, Diez-Valle R (2017) Phase I trial of DNX-2401 for diffuse intrinsic pontine glioma newly diagnosed in pediatric patients. Neurosurgery
17.
go back to reference Pfaff E, El Damaty A, Balasubramanian GP, Blattner-Johnson M, Worst BC, Stark S, Witt H, Pajtler KW, van Tilburg CM, Witt R, Milde T, Jakobs M, Fiesel P, Frühwald MC, Driever PH, Thomale UW, Schuhmann MU, Metzler M, Bochennek K, Simon T, Dürken M, Karremann M, Knirsch S, Ebinger M, von Bueren AO, Pietsch T, Herold-Mende C, Reuss DE, Kiening K, Lichter P, Eggert A, Kramm CM, Pfister SM, Jones DTW, Bächli H, Witt O (2019) Brainstem biopsy in pediatric diffuse intrinsic pontine glioma in the era of precision medicine: the INFORM study experience. Eur J Cancer 114:27–35CrossRef Pfaff E, El Damaty A, Balasubramanian GP, Blattner-Johnson M, Worst BC, Stark S, Witt H, Pajtler KW, van Tilburg CM, Witt R, Milde T, Jakobs M, Fiesel P, Frühwald MC, Driever PH, Thomale UW, Schuhmann MU, Metzler M, Bochennek K, Simon T, Dürken M, Karremann M, Knirsch S, Ebinger M, von Bueren AO, Pietsch T, Herold-Mende C, Reuss DE, Kiening K, Lichter P, Eggert A, Kramm CM, Pfister SM, Jones DTW, Bächli H, Witt O (2019) Brainstem biopsy in pediatric diffuse intrinsic pontine glioma in the era of precision medicine: the INFORM study experience. Eur J Cancer 114:27–35CrossRef
18.
go back to reference Rutkowski S, Modena P, Williamson D, Kerl K, Nysom K, Pizer B, Bartels U, Puget S, Doz F, Michalski A, von Hoff K, Chevignard M, Avula S, Murray MJ, Schönberger S, Czech T, Meeteren AYN S-v, Kordes U, Kramm CM, van Vuurden DG, Hulleman E, Janssens GO, Solanki GA, van Veelen MC, Thomale U, Schuhmann MU, Jones C, Giangaspero F, Figarella-Branger D, Pietsch T, Clifford SC, Pfister SM, Van Gool SW (2018) Biological material collection to advance translational research and treatment of children with CNS tumours: position paper from the SIOPE Brain Tumour Group. Lancet Oncol 19(8):e419–e428CrossRef Rutkowski S, Modena P, Williamson D, Kerl K, Nysom K, Pizer B, Bartels U, Puget S, Doz F, Michalski A, von Hoff K, Chevignard M, Avula S, Murray MJ, Schönberger S, Czech T, Meeteren AYN S-v, Kordes U, Kramm CM, van Vuurden DG, Hulleman E, Janssens GO, Solanki GA, van Veelen MC, Thomale U, Schuhmann MU, Jones C, Giangaspero F, Figarella-Branger D, Pietsch T, Clifford SC, Pfister SM, Van Gool SW (2018) Biological material collection to advance translational research and treatment of children with CNS tumours: position paper from the SIOPE Brain Tumour Group. Lancet Oncol 19(8):e419–e428CrossRef
Metadata
Title
Biopsy in diffuse pontine gliomas: expert neurosurgeon opinion—a survey from the SIOPE brain tumor group
Authors
Sonia Tejada
Kristian Aquilina
John Goodden
Benedetta Pettorini
Conor Mallucci
Marie Lise van Veelen
Ulrich-W. Thomale
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 4/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-020-04523-8

Other articles of this Issue 4/2020

Child's Nervous System 4/2020 Go to the issue