Pediatric Glioma: An Update of Diagnosis, Biology, and Treatment

Abstract

Recent research has promoted elucidation of the diverse biological processes that occur in pediatric central nervous system (CNS) tumors. Molecular genetic analysis is essential not only for proper classification, but also for monitoring biological behavior and clinical management of tumors. Ever since the 2016 World Health Organization classification of CNS tumors, molecular profiling has become an indispensable step in the diagnosis, prediction of prognosis, and treatment of pediatric as well as adult CNS tumors. These molecular data are changing diagnosis, leading to new guidelines, and offering novel molecular targeted therapies. The Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) makes practical recommendations using recent advances in CNS tumor classification, particularly in molecular discernment of these neoplasms as morphology-based classification of tumors is being replaced by molecular-based classification. In this article, we summarize recent knowledge to provide an overview of pediatric gliomas, which are major pediatric CNS tumors, and describe recent developments in strategies employed for their diagnosis and treatment.

Keywords: cIMPACT-NOW; molecular profiling; molecular targeted therapy; next-generation sequencing; pediatric glioma.

Figure 1

Change of treatment strategies for pediatric glioma. In treatment for pediatric glioma, because of advances of NGS, precision medicine is expected instead of evidence-based medicine. NCI-MATCH trial and Todai OncoPanel are representative precision medicine for pediatric glioma, and liquid biopsy is also expected in the future. RCT, randomized controlled trial; NGS, next-generation sequencing; CSF, cerebrospinal fluid.