title: Clinical management and outcome of histologically verified adult brainstem gliomas in Switzerland: a retrospective analysis of 21 patients.
abstract: Because of low incidence, mixed study populations and paucity of clinical and histological data, the management of adult brainstem gliomas (BSGs) remains non-standardized. We here describe characteristics, treatment and outcome of patients with exclusively histologically confirmed adult BSGs. A retrospective chart review of adults (age >18 years) was conducted. BSG was defined as a glial tumor located in the midbrain, pons or medulla. Characteristics, management and outcome were analyzed. Twenty one patients (17 males; median age 41 years) were diagnosed between 2004 and 2012 by biopsy (n = 15), partial (n = 4) or complete resection (n = 2). Diagnoses were glioblastoma (WHO grade IV, n = 6), anaplastic astrocytoma (WHO grade III, n = 7), diffuse astrocytoma (WHO grade II, n = 6) and pilocytic astrocytoma (WHO grade I, n = 2). Diffuse gliomas were mainly located in the pons and frequently showed MRI contrast enhancement. Endophytic growth was common (16 vs. 5). Postoperative therapy in low-grade (WHO grade I/II) and high-grade gliomas (WHO grade III/IV) consisted of radiotherapy alone (three in each group), radiochemotherapy (2 vs. 6), chemotherapy alone (0 vs. 2) or no postoperative therapy (3 vs. 1). Median PFS (24.1 vs. 5.8 months; log-rank, p = 0.009) and mOS (30.5 vs. 11.5 months; log-rank, p = 0.028) was significantly better in WHO grade II than in WHO grade III/IV tumors. Second-line therapy considerably varied. Histologically verification of adult BSGs is feasible and has an impact on postoperative treatment. Low-grade gliomas can simple be followed or treated with radiotherapy alone. Radiochemotherapy with temozolomide can safely be prescribed for high-grade gliomas without additional CNS toxicities.
authors.affiliation: Department of Neurology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. thomas.hundsberger@kssg.ch.|Department of Hematology and Oncology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. thomas.hundsberger@kssg.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hundsberger
authors.affiliation: Department of Neurology, and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michaela
authors.initials: M
authors.lastname: Tonder
authors.affiliation: Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hottinger
authors.affiliation: Department of Radiation Oncology, Cantonal Hospital St Gallen, St. Gallen, Switzerland.
authors.forename: Detlef
authors.initials: D
authors.lastname: Brügge
authors.affiliation: Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Roelcke
authors.affiliation: Department of Radiation Oncology, Cantonal Hospital St Gallen, St. Gallen, Switzerland.
authors.forename: Paul Martin
authors.initials: PM
authors.lastname: Putora
authors.affiliation: Department of Oncology, and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Stupp
authors.affiliation: Department of Neurology, and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Weller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001933:Brain Stem / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D020295:Brain Stem Neoplasms / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005910:Glioma / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies; D013557:Switzerland; D000077204:Temozolomide; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
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