Efficacy and influence factors of concurrent radiotherapy and chemotherapy for high-grade brainstem glioma / 中国肿瘤临床

Objective: To perform a retrospective analysis of the prognosis and influence factors of radiotherapy concurrent with che-motherapy and adjuvant temozolomide therapy in adult patients with high-grade brainstem glioma. Methods: Twenty-nine patients with pathological diagnosis of high-grade glioma (World Health Organization [WHO] Ⅲ and Ⅳ) from June 2012 to December 2013 were eligible for inclusion in the analysis. Demographic and clinical characteristics including age, gender, the time from morbidity to operation, the size of the lesion, the method of operation, the Karnofsky Performance Status (KPS) score, and the pathological grade were examined. The significance of related prognostic factors was evaluated via univariate and multivariate Logistic regression analy-sis. A P-value of<0.05 was considered to be statistically significant. Results: The median overall survival (OS) was 11.5 months. Univari-ate analysis showed that low WHO grade index was associated with better outcome (P<0.05). Multivariate analysis suggested that high KPS score (>60) and low WHO grade were associated with better survival. Conclusions: In this study, low pathological grade and high KPS score were independently associated with better survival among patients with high-grade brainstem glioma.

Application of combination of intraoperative neuroelectrophysiological monitoring and neuronavigation multi-modal fusion technology in the glioma resection / 中国神经精神疾病杂志

Objective To analyze the application of intraoperative neurophysiological monitoring combined with neuronavigation multi-modal fusion technology in the brainstem glioma resection. Methods One hundred twenty patients with brainstem glioma were divided into observation group and control group. The control group was treated by traditional operation, while the observation group was treated by intraoperative nerve electrophysiological monitoring combined with neuronavigation multimodal fusion technology. The general condition, clinical efficacy, KPS score, complications and survival rate of the two groups were compared. Results The effect was significantly better in the observation group(76.66%)than in control group(53.33%)( x2=11.962,P=0.001).KPS scores were significantly higher in the observation group (27.91 ±1.98) than in the control group (12.11 ±2.13)(t=32.669, P<0.001). Conclusions Intraoperative nerve electrophysiological monitoring plus neuronavigation multimodality fusion technology can improve clinical efficacy and quality of life in patients with brainstem glioma.

Overview of CNS Gliomas in Childhood / 임상소아혈액종양

Brain tumor is the second most common tumor in childhood. The overall survival (OS) has improved significantly during the past 30 years due to developments in surgical technique, radiotherapy, chemotherapy, and high-dose chemotherapy and autologous peripheral stem cell rescue. At present, the 5 year OS of pediatric brain tumor is about 75% which, however, is still lower than that of other malignancies in childhood. Various clinical studies using radiotherapy combined with chemotherapy, multidrug chemotherapy, and monoclonal antibody have been conducted in order to cure patients with brain tumor. The Korean Society of Pediatric Neuro-Oncology is trying to develop standard therapy for the various types of pediatric brain tumor. Of special note, the standard treatment for pediatric glioma has not yet been established. Glioma is the most common histologic type of brain tumor in children. They are classified into 3 groups based on the WHO grade and location of tumor; low-grade glioma (LGG), high-grade glioma (HGG), and brainstem glioma (BSG). The prognosis of LGG is usually good if a complete surgical resection is feasible. Incomplete resected or progressive LGG are troublesome disease for pediatric oncologists. The survival rate of HGG and BSG is very low in spite of combined treatments with surgery, radiation, and chemotherapy. The aim of this review is to provide an overview of treatments for pediatric gliomas.

Overview of CNS Gliomas in Childhood / 임상소아혈액종양

Brain tumor is the second most common tumor in childhood. The overall survival (OS) has improved significantly during the past 30 years due to developments in surgical technique, radiotherapy, chemotherapy, and high-dose chemotherapy and autologous peripheral stem cell rescue. At present, the 5 year OS of pediatric brain tumor is about 75% which, however, is still lower than that of other malignancies in childhood. Various clinical studies using radiotherapy combined with chemotherapy, multidrug chemotherapy, and monoclonal antibody have been conducted in order to cure patients with brain tumor. The Korean Society of Pediatric Neuro-Oncology is trying to develop standard therapy for the various types of pediatric brain tumor. Of special note, the standard treatment for pediatric glioma has not yet been established. Glioma is the most common histologic type of brain tumor in children. They are classified into 3 groups based on the WHO grade and location of tumor; low-grade glioma (LGG), high-grade glioma (HGG), and brainstem glioma (BSG). The prognosis of LGG is usually good if a complete surgical resection is feasible. Incomplete resected or progressive LGG are troublesome disease for pediatric oncologists. The survival rate of HGG and BSG is very low in spite of combined treatments with surgery, radiation, and chemotherapy. The aim of this review is to provide an overview of treatments for pediatric gliomas.

Clinical study on the corration of pathological classification of brainstem glioma with MRI ;imaging / 中国医学装备

Objective:To explore the corration of pathological classification of brainstem glioma with MRI imaging. Methods: The clinical data of 98 patients with BSG was retrospectively analyzed. of 98 patients, 66 cases were low level of brainstem gliomas, 32 cases were high level of brainstem gliomas. MRI images of different pathological grading of BSG were analyzed. Results:Glioma growth way was similar between the two groups and there was no statistical significance. But the proportion of basal artery circumvolutio, necrosis, growth across the midline of the high level group were significantly higher than the control group, there was a significant statistical significance (P2 cm in diameter was higher than the control group, and the difference was statistically significant (P<0.05). The improved forms of high level group were mainly wreath, wall nodules (P<0.01), and improved significantly stronger than the low level group (P<0.01). The main uniformity of high level group in show was characteristics with less uniformity (P<0.01). The MRI measuring minimum thickness was similar between the two groups and had no statistical significance. But MRI measuring thickness, the ratio and gap between maximum thickness and minimum thickness of high level group were bigger than the value of low level group, with statistically significant difference (P<0.001). Conclusion:MRI imaging and MRI enhanced characteristics of brainstem glioma may predict and judge the malignant degree and pathological grading of brainstem glioma.

Outcome and Prognostic Factors of Childhood Diffuse Brainstem Glioma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The outcome and prognostic factors of brainstem glioma were evaluated following radiotherapy methods. MATERIALS AND METHODS: Between 1986 and 2001, 45 childhood patients with diffuse brainstem glioma were treated. There were 26 boys and 19 girls, with a median age of 7 years (range 3~18). The histopathological diagnoses were confirmed in 13 patients, which revealed a low-grade glioma in four patients, and high-grade glioma in the other nine. Before 1993, radiation therapy using a regime of 1.8 to 2.0 Gy once a day was performed in 16 cases; thereafter, a regimes of 1.1 or 1.5 Gy twice a day was given in 15 and 14 cases, respectively. Nine patients were treated with adjuvant chemotherapy. The response to the treatment was evaluated by the MRI findings 4 weeks after radiotherapy. RESULTS: After radiotherapy, the neurological deficit improved in 42 of the 45 patients (93%). The MRI responses were as follows; partial response 22/39 (56%), minimal to no response in 16/39 (41%) and tumor progression in 1/39 (3%). The median time to disease progression was 7 months, and the median survival was 12 months; the overall survival rate at 1 year was 41%. There was no significant prognostic factor for overall survival. The progression-free survival was influenced by the tumor histology (low grade vs. high grade, p=0.05) in those patients whose pathology was confirmed. CONCLUSION: The radiation therapy fractionation schedule did not influence the survival. Low grade histology was a possible favorable prognostic factor of progression-free survival in pediatric brainstem glioma patients.

Brainstem Glioma: Survival and Prognostic Factors

OBJECTIVE: To clarify the biological behavior and prognostic factors of brain stem gliomas, the authors reviewed 48 patients with brain stem gliomas treated between 1980 and 1996. PATIENTS AND METHOD: The clinical presentation, tumor location, pathology, and treatment modalities were correlated with the prognosis of these tumors. Male to female ratio was 1.1:1, with the median age of 12.5 years. Thirty patients(63%) were below 15 years old, and 18 patients(38%) were of adult ages. Mean follow up period was 21.8 months. RESULTS: Focal tumors were in 22 cases and diffuse tumors were in 26. All nine midbrain tumors were focal type. Twenty-two(92%) cases among 24 potine tumors were diffuse type and two cases were focal type as dorsally exophytic tumor. Eleven(73%) cases among 15 medullary and cervicomedullary tumors were focal type and four(27%) cases were diffuse type. Pathologically, there were 14 anaplastic astrocytomas, 11 low grade astrocytomas, 4 glioblastomas, 3 oligodendrogliomas, and 1 ganglioglioma. Fifteen tumors were diagnosed only radiologically without histologic verification. Surgery was done in 33 patients(gross total or subtotal removal in 8, biopsy or partial removal in 15, stereotactic biopsy in 10). Radiation therapy was given in 41 patients(conventional in 29, hyperfractionated in 12). Chemotherapy was done in four patients. CONCLUSION: Statistically significant prognostic factors were symptom duration prior to diagnosis(p=0.0004), cranial nerve palsy(p=0.0206), extent of tumor growth(p=0.0219), contrast enhancement(p=0.0226), intratumoral cyst(p=0.047), histopathological grading(p=0.0304), surgery in patients with focal tumors(p=0.0018), and radiation therapy(p=0.0149).

Brainstem Gliomas: Classification, Growth Patterns, and Prognosis

Brainstem glimas are common intracranial tumors in young age and have dismal prognosis despite the advance in diagnostic and treatment modalities. The purpose of this study is to classify the brainstem gliomas by growth patterns and to correlate the growth patterns with histological findings. With these results,we have studied further to verify the prognostic factors in brainstem gliomas. Sixty four patients with brainstem gliomas were treated between May, 1989 and March, 1997. For the location of brainstem gliomas, 41 cases were in pons, 13 cases in medulla, 8 cases in midbrain, and 2 disseminated cases. Operations were performed in 44 cases of these lesions which were focally enhanced type or had exophytic growth patterns. Histological diagnoses were low grade gliomas in 22 cases and high grade gliomas in 21 cases. Among them, radiotherapy was performed in 39 patients with diffuse or disseminated type. Among operated pateints, seven were treated with Gamma Knife radiosurgery for focal residual lesion. Diffuse types were more common in pons. Exophytic or focal types were common in medulla and midbrain. High grade glioma was more common in diffuse type and low grade glioma was common in exophytic or focal type. We concluded that the favorable prognostic factors are long duration of symptoms(>2mos), exophytic type, low grade glioma, and radiotherapy treatment.

Brainstem Tumors : Results of 20 Patients Treated with Radiation Therapy / 대한치료방사선과학회지

A total of 20 patients(male : female=10:10, adult : children=8:12) with brainstem tumors had been received radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between 1980 and 1990. Thirteen of 20 patients were treated with conventional radiation therapy (before 1989, 180~200 cGy per fraction, 5 days a week, total dose 4680~5400 cGy), and seven patients were treated with hypefractionated radiation therapy(in 1990, 100 cGy per fraction, twice daily 10 fractions a week, total dose 7200 cGy). Median follow up periods for conventional radiation therapy group and hyperfractionated radiation therapy group were 39 months and 10 months, respectively. Four of 20 Patients had histopathologic diagnosis prior to treatment ; 3 cases were low grade astrocytoma and 1 case was high grade astrocytoma. Overall 2-year actuarial survival rate was 30%. The prognosis of patients with a longer duration of symptom and sign was better(60% vs 12%), and the adult(52%) was better than children(14%). There was no significant difference between the focal(29%) and diffuse(20%) type. The initial clinical response was better in the hyperfractionated radiation therapy group. Because of the relatively small number of Patients and short follow up Period in hyPerFractionated radiation therapy group, there was no comparison between two group.

Clinical observation on brainstem glioma in childhood

No abstract available.