Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma

• Published in: Cancer 2006-03, Vol.106 (6), p.1364-1371
• Main Authors: Broniscer, Alberto, Laningham, Fred H., Kocak, Mehmet, Krasin, Matthew J., Fouladi, Maryam, Merchant, Thomas E., Kun, Larry E., Boyett, James M., Gajjar, Amar
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Brain Stem Neoplasms - diagnosis; Brain Stem Neoplasms - drug therapy; Brain Stem Neoplasms - radiotherapy; brainstem; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - etiology; chemotherapy; Child; Child, Preschool; children; Combined Modality Therapy; Cranial Irradiation; Female; glioma; Glioma - diagnosis; Glioma - drug therapy; Glioma - radiotherapy; hemorrhage; Humans; intratumoral; Magnetic Resonance Imaging; Male; Medical sciences; Necrosis; Neurology; Prognosis; radiation therapy; Retrospective Studies; Survival Rate; Treatment Outcome; Tumors; Tumors of the nervous system. Phacomatoses
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21749

BACKGROUND Children with diffuse brainstem glioma (BSG) commonly undergo novel therapies because their outcome is poor with radiation therapy (RT). Although recent clinical trials using new biologic agents documented intratumoral hemorrhage (IH) among several children with BSG, to the authors' knowledge little is known regarding this phenomenon. In the current study, the authors assessed the characteristics and estimated the cumulative incidence of IH among children with BSG. METHODS All available brain imaging studies and medical records of 48 consecutive patients with newly diagnosed BSG treated at the study institution over a 10‐year interval (1992–2002) were reviewed. Treatment was comprised of RT and various regimens of conventional chemotherapy; none of these patients received biologic agents. At the time of last follow‐up, all patients had died of tumor progression. RESULTS The authors reviewed 319 imaging studies (251 magnetic resonance imaging scans and 68 computed tomography scans). IH was present in 6.25% of patients at the time of diagnosis. The 6‐month and 12‐month cumulative incidence estimates of IH regardless of the associated symptoms were 15.5% ± 5.5% and 24.4% ± 6.5%, respectively. The same estimates for symptomatic cases were 8.9% ± 4% and 17.8% ± 6%, respectively. All cases of IH at the time of diagnosis and 78% of symptomatic cases that developed after diagnosis were located in necrotic areas. CONCLUSIONS Although IH is uncommon at the time of diagnosis, symptomatic IH may occur among nearly 20% of children after the diagnosis of BSG. The uniform occurrence of IH among patients treated with various chemotherapeutic regimens and its association with necrotic areas suggests that tumor biology plays a significant role in this event. Cancer 2006. © 2006 American Cancer Society. Although intratumoral hemorrhage is uncommonly observed at the time of diagnosis in children with diffuse brainstem glioma, close to 20% of these patients will develop symptomatic intratumoral hemorrhage after diagnosis. The results of the current study suggest that the occurrence of intratumoral hemorrhage appears to depend in large part on the intrinsic characteristics of these tumors.