title: Treatment options in childhood pontine gliomas.
abstract: 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.
authors.affiliation: Department of Pediatric Oncology, Krankenhaus der Barmherzigen Brüder Klinik St. Hedwig, Regensburg, Germany. sabine.wagner@barmherzige-regensburg.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Wagner
authors.forename: Monika
authors.initials: M
authors.lastname: Warmuth-Metz
authors.forename: Angela
authors.initials: A
authors.lastname: Emser
authors.forename: Astrid-K
authors.initials: AK
authors.lastname: Gnekow
authors.forename: Ronald
authors.initials: R
authors.lastname: Sträter
authors.forename: Stefan
authors.initials: S
authors.lastname: Rutkowski
authors.forename: Norbert
authors.initials: N
authors.lastname: Jorch
authors.forename: Hans-J
authors.initials: HJ
authors.lastname: Schmid
authors.forename: Frank
authors.initials: F
authors.lastname: Berthold
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
authors.forename: Rolf-D
authors.initials: RD
authors.lastname: Kortmann
authors.forename: Thorsten
authors.initials: T
authors.lastname: Pietsch
authors.forename: Norbert
authors.initials: N
authors.lastname: Sörensen
authors.forename: Ove
authors.initials: O
authors.lastname: Peters
authors.forename: Johannes E A
authors.initials: JE
authors.lastname: Wolff
mesh_terms: 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