Brainstem Glioma: Survival and Prognostic Factors

ABSTRACT

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 1.11, 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).