Clinico-radiologic characteristics of long-term survivors of diffuse intrinsic pontine glioma

Abstract

Diffuse intrinsic pontine glioma (DIPG) is the deadliest central nervous system tumor in children. The survival of affected children has remained poor despite treatment with radiation therapy (RT) with or without chemotherapy. We reviewed the medical records of all surviving patients with DIPG treated at our institution between October 1, 1992 and May 31, 2011. Blinded central radiologic review of the magnetic resonance imaging at diagnosis of all surviving patients and 15 controls with DIPG was performed. All surviving patients underwent neurocognitive assessment during follow-up. Five (2.6 %) of 191 patients treated during the study period were surviving at a median of 9.3 years from their diagnosis (range 5.3-13.2 years). Two patients were younger than 3 years, one lacked signs of pontine cranial nerve involvement, and three had longer duration of symptoms at diagnosis. One patient had a radiologically atypical tumor and one had a tumor originating in the medulla. All five patients received RT. Chemotherapy was variable among these patients. Neurocognitive assessments were obtained after a median interval of 7.1 years. Three of four patients who underwent a detailed evaluation showed cognitive function in the borderline or mental retardation range. Two patients experienced disease progression at 8.8 and 13 years after diagnosis. A minority of children with DIPG experienced long-term survival with currently available therapies. These patients remained at high risk for tumor progression even after long follow-ups. Four of our long-term survivors had clinical and radiologic characteristics at diagnosis associated with improved outcome.

Figure 1

Fig. 1a T2-weighted axial brain MRI of patient 2 at diagnosis Fig. 1b T2-weighted axial brain MRI of patient 2 obtained 12.2 years after her diagnosis and before tumor progression

Figure 1

Fig. 1a T2-weighted axial brain MRI of patient 2 at diagnosis Fig. 1b T2-weighted axial brain MRI of patient 2 obtained 12.2 years after her diagnosis and before tumor progression

Fig. 2

Intelligence scores of surviving patients Of note, patient 1 only underwent testing by Wechsler intelligence scale for children, 4^th edition (WISC-IV) because of significant dysarthria Abbreviations: FSIQ, full scale intellectual quotient; VCI, verbal comprehension index; PRI, perceptual reasoning index; WMI, working memory index; PSI, processing speed index