Clinical management and outcome of histologically verified adult brainstem gliomas in Switzerland: a retrospective analysis of 21 patients

• Published in: Journal of neuro-oncology 2014-06, Vol.118 (2), p.321-328
• Main Authors: Hundsberger, Thomas, Tonder, Michaela, Hottinger, Andreas, Brügge, Detlef, Roelcke, Ulrich, Putora, Paul Martin, Stupp, Roger, Weller, Michael
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Alkylating - therapeutic use; Brain Stem - drug effects; Brain Stem - pathology; Brain Stem - radiation effects; Brain Stem - surgery; Brain Stem Neoplasms - genetics; Brain Stem Neoplasms - pathology; Brain Stem Neoplasms - therapy; Clinical Study; Dacarbazine - analogs & derivatives; Dacarbazine - therapeutic use; Female; Glioma - genetics; Glioma - pathology; Glioma - therapy; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neurology; Oncology; Retrospective Studies; Switzerland; Treatment Outcome; Young Adult
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-014-1434-1

Because of low incidence, mixed study populations and paucity of clinical and histological data, the management of adult brainstem gliomas (BSGs) remains non-standardized. We here describe characteristics, treatment and outcome of patients with exclusively histologically confirmed adult BSGs. A retrospective chart review of adults (age >18 years) was conducted. BSG was defined as a glial tumor located in the midbrain, pons or medulla. Characteristics, management and outcome were analyzed. Twenty one patients (17 males; median age 41 years) were diagnosed between 2004 and 2012 by biopsy ( n  = 15), partial ( n  = 4) or complete resection ( n  = 2). Diagnoses were glioblastoma (WHO grade IV, n  = 6), anaplastic astrocytoma (WHO grade III, n  = 7), diffuse astrocytoma (WHO grade II, n  = 6) and pilocytic astrocytoma (WHO grade I, n  = 2). Diffuse gliomas were mainly located in the pons and frequently showed MRI contrast enhancement. Endophytic growth was common (16 vs. 5). Postoperative therapy in low-grade (WHO grade I/II) and high-grade gliomas (WHO grade III/IV) consisted of radiotherapy alone (three in each group), radiochemotherapy (2 vs. 6), chemotherapy alone (0 vs. 2) or no postoperative therapy (3 vs. 1). Median PFS (24.1 vs. 5.8 months; log-rank, p  = 0.009) and mOS (30.5 vs. 11.5 months; log-rank, p  = 0.028) was significantly better in WHO grade II than in WHO grade III/IV tumors. Second-line therapy considerably varied. Histologically verification of adult BSGs is feasible and has an impact on postoperative treatment. Low-grade gliomas can simple be followed or treated with radiotherapy alone. Radiochemotherapy with temozolomide can safely be prescribed for high-grade gliomas without additional CNS toxicities.