Andrea Rigamonti1, Giorgia Simonetti2, Antonio Silvani2, Roberta Rudà3, Federica Franchino3, Veronica Villani4, Andrea Pace4, Rossella Merli5, Maura Servida6, Alberto Picca7, Giulia Berzero7, Alfonso Cerase8, Ivano Chiarotti8, Giannantonio Spena9, Andrea Salmaggi9. 1. Neurosciences Department, Neurology Unit, Ospedale A. Manzoni, ASST Lecco, Via Dell'Eremo 9/11, 23900, Lecco, Italy. rig74@libero.it. 2. Clinical Neurooncology Unit, Neurooncology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy. 3. Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy. 4. Neurooncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. 5. Neurosurgery Unit, ASST PgXXIII, Bergamo, Italy. 6. Department of Neurology, ASST Ovest Milanese - Legnano Hospital, Legnano, Italy. 7. Neurooncology Unit, IRCCS C. Mondino Foundation, Pavia, Italy. 8. Unit of Neuroimaging - Diagnostic and Functional Neuroradiology Department of Neurological and Human Movement Sciences "Santa Maria alle Scotte", NHS & University General Hospital, Tuscany, Siena, Italy. 9. Neurosciences Department, Neurology Unit, Ospedale A. Manzoni, ASST Lecco, Via Dell'Eremo 9/11, 23900, Lecco, Italy.
Abstract
BACKGROUND AND PURPOSE: Adult brainstem gliomas are rare primary brain tumours with heterogeneous clinical course. The low frequency of these tumours makes it difficult to achieve high-quality evidence regarding prognostic factors, adequate therapeutic approach and outcome in such patients. METHODS: In this retrospective study, we analysed clinical, radiological, molecular, prognostic and therapeutic factors in a series of 47 histologically proven adult brainstem gliomas recruited over a 20-year period (1998-2018). RESULTS: Twenty-two patients were male, 25 female with median age of 39 years. The tumour involved one brainstem segment in 20 cases and 2 or more segments in 27. Contrast enhancement was reported in 28 cases. Surgical procedures included biopsy in 26 cases and partial/total resection in the remaining 21. Histological diagnosis was of low-grade glioma in 23 patients, high-grade glioma in 22 and non-diagnostic in 2 cases. Data regarding molecular biology were available for 22 patients. Median overall survival was 35 months, in particular 16 months in high-grade glioma and 84 months in low-grade glioma. At univariate analysis, tumour grade was the only factor with a statistically significant impact on survival time (p = 0,003), whereas younger age, better performance status and total/subtotal resection showed a trend to more prolonged survival. This study also confirms safety of biopsy/surgery in adult brainstem glioma patients and shows a clear trend to a more frequent assessment of molecular biology data. CONCLUSIONS: Further prospective multicentre efforts, and hopefully clinical trials, are necessary to improve outcome in this neglected glioma patient population.
BACKGROUND AND PURPOSE: Adult brainstem gliomas are rare primary brain tumours with heterogeneous clinical course. The low frequency of these tumours makes it difficult to achieve high-quality evidence regarding prognostic factors, adequate therapeutic approach and outcome in such patients. METHODS: In this retrospective study, we analysed clinical, radiological, molecular, prognostic and therapeutic factors in a series of 47 histologically proven adult brainstem gliomas recruited over a 20-year period (1998-2018). RESULTS: Twenty-two patients were male, 25 female with median age of 39 years. The tumour involved one brainstem segment in 20 cases and 2 or more segments in 27. Contrast enhancement was reported in 28 cases. Surgical procedures included biopsy in 26 cases and partial/total resection in the remaining 21. Histological diagnosis was of low-grade glioma in 23 patients, high-grade glioma in 22 and non-diagnostic in 2 cases. Data regarding molecular biology were available for 22 patients. Median overall survival was 35 months, in particular 16 months in high-grade glioma and 84 months in low-grade glioma. At univariate analysis, tumour grade was the only factor with a statistically significant impact on survival time (p = 0,003), whereas younger age, better performance status and total/subtotal resection showed a trend to more prolonged survival. This study also confirms safety of biopsy/surgery in adult brainstem gliomapatients and shows a clear trend to a more frequent assessment of molecular biology data. CONCLUSIONS: Further prospective multicentre efforts, and hopefully clinical trials, are necessary to improve outcome in this neglected gliomapatient population.