Treatment options in childhood pontine gliomas.
BACKGROUND
Pontine gliomas are the subgroup of brainstem gliomas with the worst prognosis. Controversial treatment approaches are discussed.


METHODS
Data of children with pontine gliomas treated in different prospective multi-center studies who were registered in the HIT-GBM database were pooled and analyzed addressing prognostic factors and the relevance of intensive treatment using contingency tables, Kaplan-Meier curves and Cox regression analyses.


RESULTS
From 1983 to 2001, 153 patients (74 males, 79 females, mean age: 8.1 years) with pontine gliomas were registered. Twenty-one tumors were low-grade and 60 were high-grade gliomas (72 undefined histology: 67 no surgery, 5 incomplete data). Sixteen tumors were partially resected, and 125 were irradiated. Ninety children received chemotherapy according to the "HIT-GBM" protocols ("Hirntumor-Glioblastoma multiforme"). The one-year overall survival rate (1YOS) of all patients with pontine glioma was 39.9+/-4.3%. None of the surviving patients had an observation time longer than 3.9 years. Favorable prognostic factors seemed to be age younger than 4 years, low-grade histology and smaller tumor. All three major treatment modalities including resection, irradiation and chemotherapy had prognostic relevance in univariable analysis. Chemotherapy remained beneficial, even if the analysis was restricted to the subgroup of irradiated tumors (1YOS 45.8+/-5.4% vs. 34.4+/-13.5%, P=0.030).


CONCLUSIONS
Irradiation is an effective element for the treatment of pontine gliomas. Intensive chemotherapy seems to be important in achieving a better OS.
Wagner
Sabine
S
Department of Pediatric Oncology, Krankenhaus der Barmherzigen Brüder Klinik St. Hedwig, Regensburg, Germany. sabine.wagner@barmherzige-regensburg.de
Warmuth-Metz
Monika
M
Emser
Angela
A
Gnekow
Astrid-K
AK
Sträter
Ronald
R
Rutkowski
Stefan
S
Jorch
Norbert
N
Schmid
Hans-J
HJ
Berthold
Frank
F
Graf
Norbert
N
Kortmann
Rolf-D
RD
Pietsch
Thorsten
T
Sörensen
Norbert
N
Peters
Ove
O
Wolff
Johannes E A
JE
D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D020295:Brain Stem Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002648:Child; D002986:Clinical Trials as Topic; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D019635:Neurosurgical Procedures; D011149:Pons / Q000473:pathology*; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D016019:Survival Analysis