title: Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma.
abstract: 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.
authors.affiliation: Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105, USA. alberto.broniscer@stjude.org
authors.forename: Alberto
authors.initials: A
authors.lastname: Broniscer
authors.forename: Fred H
authors.initials: FH
authors.lastname: Laningham
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kocak
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Krasin
authors.forename: Maryam
authors.initials: M
authors.lastname: Fouladi
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: James M
authors.initials: JM
authors.lastname: Boyett
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009336:Necrosis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents