Treatment of diffuse intrinsic brainstem gliomas: Failed approaches and future strategies - A review

James L. Frazier, James Lee, Ulrich W. Thomale, Joseph C. Noggle, Kenneth J. Cohen, George I. Jallo

Research output: Contribution to journalReview articlepeer-review

Abstract

Diffuse intrinsic pontine gliomas constitute ∼ 60-75% of tumors found within the pediatric brainstem. These malignant lesions present with rapidly progressive symptoms such as cranial nerve, long tract, or cerebellar dysfunctions. Magnetic resonance imaging is usually sufficient to establish the diagnosis and obviates the need for surgical biopsy in most cases. The prognosis of the disease is dismal, and the median survival is < 12 months. Resection is not a viable option. Standard therapy involves radiotherapy, which produces transient neurological improvement with a progression-free survival benefit, but provides no improvement in overall survival. Clinical trials have been conducted to assess the efficacy of chemotherapeutic and biological agents in the treatment of diffuse pontine gliomas. In this review, the authors discuss recent studies in which systemic therapy was administered prior to, concomitantly with, or after radiotherapy. For future perspective, the discussion includes a rationale for stereotactic biopsies as well as possible therapeutic options of local chemotherapy in these lesions.

Original languageEnglish (US)
Pages (from-to)259-269
Number of pages11
JournalJournal of Neurosurgery: Pediatrics
Volume3
Issue number4
DOIs
StatePublished - Apr 1 2009

Keywords

  • Chemotherapy
  • Diffuse intrinsic brainstem glioma
  • Local drug delivery
  • Radiotherapy
  • Stereotactic biopsy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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