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Child's Nervous System

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01-04-2013 | Original Paper

Pediatric diffuse intrinsic pontine glioma patients from a single center

Authors: Rejin Kebudi, Fatma Betul Cakir, Fulya Yaman Agaoglu, Omer Gorgun, Inci Ayan, Emin Darendeliler

Published in: Child's Nervous System | Issue 4/2013

Abstract

Background

The prognosis of children with diffuse intrinsic pontine gliomas (DIPG) is dismal. This study aims to evaluate the characteristics and treatment outcome of children with DIPG in a single center.

Methods

We reviewed the outcome of children with DIPG treated at the Oncology Institute of Istanbul University from February 1999 to May 2012.

Results

Fifty children (26 female, 24 male) with the median age of 7 years were analyzed. The median duration of symptoms was 30 days. All patients received radiotherapy (RT). Before the year 2000, 12 patients received only RT. Thirty-eight had concomitant and/or adjuvant chemotherapy with RT. Between 2000 and 2004, 17 patients received cis-platinum or vincristine as sensitizers during RT and CCNU + vincristine combination after RT. Since 2004, 21 patients received temozolomide (TMZ) concomitantly during RT and as adjuvant chemotherapy after RT. The median survival time of all patients was 13 months (1–160 months). Patients receiving RT + TMZ had a significantly higher overall survival than patients with only RT (p = 0.018). Patients receiving RT + chemotherapy other than TMZ also had a significantly higher overall survival than patients receiving only RT (p = 0.013). Patients receiving RT + TMZ + and chemotherapy other than TMZ had a significantly higher survival than patients receiving only RT (p = 0.005).

Conclusion

In our series, patients receiving RT + TMZ and also patients receiving RT + chemotherapy other than TMZ had a significantly higher overall survival than patients treated with only RT. Hence, administering chemotherapy during and after RT seems to prolong survival in some DIPG patients.

Akyuz C, Demir HA, Varan A, Yalçin B, Kutluk T, Büyükpamukçu M (2012) Temozolomide in relapsed pediatric brain tumors: 14 cases from a single center. Childs Nerv Syst 28:111–115PubMedCrossRef

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 33:1026–1029PubMedCrossRef

Bernier-Chastagner V, Grill J, Doz F, Bracard S, Gentet JC, Marie-Cardine A et al (2005) Topotecan as a radiosensitizer in the treatment of children with malignant diffuse brain stem gliomas: results of a French Society of Paediatric Oncology Phase II Study. Cancer 104:2792–2797PubMedCrossRef

Broniscer A, Iacono L, Chintagumpala M, Fouladi M, Wallace D, Bowers DC, Stewart C, Krasin MJ, Gajjar A (2005) Role of temozolomide after radiotherapy for newly diagnosed diffuse brain stem glioma in children: results of a multiinstitutional study (SJHG-98). Cancer 103:133–139PubMedCrossRef

Chassot A, Canale S, Varlet P, Puget S, Roujeau T, Negretti L, Dhermain F, Rialland X, Raquin MA, Gril J, Dufour C (2012) Radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma. J Neurooncol 106:399–407PubMedCrossRef

Chiang KL, Chang KP, Lee YY, Huang PI, Hsu TR, Chen YW, Chang FC, Wong TT (2010) Role of temozolomide in the treatment of newly diagnosed diffuse brainstem glioma in children: experience at a single institution. Childs Nerv Syst 26: 1035–1041

Cohen K, Heideman R, Zhou T, Holmes EJ, Lavey RS, Bouffet E, Pollack IF (2011) Temozolomide in the treatment of children with newly diagnosed diffuse intrinsic pontine gliomas: a report from the Children’s Oncology Group. Neuro Oncol 4:410–416CrossRef

Donaldson SS, Laningham F, Fisher PG (2006) Advances toward an understanding of brain stem gliomas. J Clin Oncol 24:1266–1272PubMedCrossRef

Doz F, Neuenschwander S, Bouffet E, Gentet JC, Schneider P, Kalifa C et al (2002) Carboplatin before and during radiation therapy for the treatment of malignant brain stem tumours: a study by the Société Française d’Oncologie Pédiatrique. Eur J Cancer 38:815–819PubMedCrossRef

10.

Fischbein NJ, Prados MD, Wara W, Russo C, Edwards MS, Barkovich AJ (1996) Radiologic classification of brain stem tumors: correlation of magnetic resonance imaging appearance with clinical outcome. Pediatr Neurosurg 24:9–23PubMedCrossRef

11.

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 89:1569–1576PubMedCrossRef

12.

Grigsby PW, Thomas PRM, Schwartz HG, Fineberg B (1987) Irradiation of primary thalamic and brain stem tumors in a pediatric population: a 33-year experience. Cancer 60:2901–2906PubMedCrossRef

13.

Guillamo JS, Monjour A, Taillandier L, Devaux B, Haie-Meder C, Defer GL, Maison P, Mazeron JJ, Cornu P, Delattre JY (2001) Brainstem gliomas in adults: prognostic factors and classification. Brain 124:2528–2539PubMedCrossRef

14.

Hargrave D, Bartels U, Bouffet E (2006) Diffuse brainstem glioma in children: critical review of clinical trials. Lancet Oncol 7:241–248PubMedCrossRef

15.

Jalali R, Raut N, Arora B, Gupta T, Dutta D, Munshi A, Sarin R, Kurkure P (2010) Prospective evaluation of radiotherapy with concurrent and adjuvant temozolamide in children with newly diagnosed diffuse intrinsic pontine glioma. Int J Radiat Oncol Biol Phys 77:113–118PubMedCrossRef

16.

Jennings M, Spotso R, Boyett JM, Vezina LG, Holmes E, Berger MS et al (2002) Preradiation chemotherapy in primary high-risk brainstem tumors: phase II study CCG-9941 of the Children’s Cancer Group. J Clin Oncol 20:3431–3437PubMedCrossRef

17.

Kim CY, Kim SK, Phi JH, Lee MM, Kim IA, Kim IH, Wang KC, Jung HL, Lee MJ, Cho BK (2010) A prospective study of temozolomide plus talidomide during and after radiation therapy for pediatric diffuse pontine gliomas: preliminary results of the Korean Society for Pediatric Neuro-Oncology study. J Neurooncol 100:193–198PubMedCrossRef

18.

Lashford LS, Thiesse P, Jouvet A, Jaspan T, Couanet D, Griffiths PD, Doz F, Ironside J et al (2002) 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 20:4684–4691PubMedCrossRef

19.

Littman P, Jarrett P, Bilaniuk LT, Rorke LB, Zimmerman RA, Bruce DA, Carabell SC, Schut L et al (1980) Pediatric brain stem gliomas. Cancer 45:2787–2792PubMedCrossRef

20.

Maria BL, Rehder K, Eskin TA, Hamed LM, Fennell EB, Quisling RG, Mickle JP, Marcus RB Jr, Drane WE, Mendenhall NP et al (1993) Brainstem glioma: I. Pathology, clinical features, and therapy. J Child Neurol 8:112–128PubMedCrossRef

21.

Massimino M, Spreafico F, Biassoni V, Simonetti F, Riva D, Trecate G, Giombini S, Poggi G, Pecori E, Pignoli E et al (2008) Diffuse pontine gliomas in children: changing strategies, changing results? A mono-institutional 20-year experience. J Neurooncol 87:355–361PubMedCrossRef

22.

Packer RJ (1996) Brain tumors in children. Curr Opin Pediatr 8:549–557PubMedCrossRef

23.

Packer RJ, Boyett JM, Zimmerman RA, Rorke LB, Kaplan AM, Albright AL et al (1993) Hyperfractionated radiation therapy (72 Gy) for children with brain stem gliomas: a Children’s Cancer Group phase I/II trial. Cancer 72:1414–1421PubMedCrossRef

24.

Paugh BS, Qu C, Jones C, Liu Z, Adamowicz-Brice M, Zhang J et al (2010) Integrated molecular genetic profiling of pediatric high-grade gliomas reveals key differences with the adult disease. J Clin Oncol 28:3061–3068PubMedCrossRef

25.

Perry JR, Belanger K, Mason WP, Fulton D, Kavan P, Easaw J, Shields C, Kirby S, Macdonald DR, Eisenstat DD, Thiessen B, Forsyth P, Pouliot JF (2010) Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol 28:2051–2057PubMedCrossRef

26.

Sirachainan N, Pakakasama S, Visudithbhan A, Chiamchanya S, Tuntiyatorn L, Dhanachai M, Laothamatas J, Hongeng S (2008) Concurrent radiotherapy with temozolomide followed by adjuvant temozolomide and cis-retinoic acid in children with diffuse intrinsic pontine glioma. Neuro Oncol 10:577–582PubMedCrossRef

27.

Temel JS, Greer JA, Muzikansky A, Gallaqher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742PubMedCrossRef

28.

Wagner S, Warmuth-Metz M, Esmer A, Gnekow AK, Strater R, Rutkowski S et al (2006) Treatment options in childhood pontine gliomas. J Neurooncol 79:281–287PubMedCrossRef

29.

Wong TT, Ho DM, Chang KP, Yen SH, Guo WY, Chang FC, Liang ML, Pan HC, Chung WY (2005) Primary pediatric brain tumors: statistics of Taipei VGH, Taiwan (1975–2004). Cancer 104:2156–2167PubMedCrossRef

30.

Zarghooni M, Bartels U, Lee E, Buczkowicz P, Morrison A, Huang A, Bouffet E, Hawkins C (2010) Whole-genome profiling of pediatric diffuse intrinsic pontine gliomas highlights platelet-derived growth factor receptor alpha and poly (ADP-ribose) polymerase as potential therapeutic targets. J Clin Oncol 28:1337–1344PubMedCrossRef

Title: Pediatric diffuse intrinsic pontine glioma patients from a single center
Authors: Rejin Kebudi
Fatma Betul Cakir
Fulya Yaman Agaoglu
Omer Gorgun
Inci Ayan
Emin Darendeliler
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Child's Nervous System / Issue 4/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-012-1986-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pediatric diffuse intrinsic pontine glioma patients from a single center

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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