Adult brainstem gliomas: Correlation of clinical and molecular features.
BACKGROUND
Brainstem gliomas are rare in adults and overall have superior survival outcomes compared to pediatric brainstem gliomas.


METHODS
We conducted a retrospective data and tissue analysis of all adult patients (≥ 18 years old) with World Health Organization (WHO) Grade II, III, and IV brainstem gliomas in the University of Texas MD Anderson Cancer Center institutional database from 1990 to 2012.


RESULTS
We identified 143 cases in adults ages 18 and over. There were 28 glioblastomas, 43 anaplastic astrocytomas, 15 diffuse astrocytomas, and 11 gliomas not otherwise specified, and in 46 cases the diagnosis was made radiographically. 128 (89.5%) cases were classified radiographically as diffuse and of the focal tumors, 9 of the 15 were WHO Grade III or IV tumors. Increasing tumor grade and contrast enhancement were associated with significantly reduced overall survival. The median overall survival for the entire cohort was 32.1 months similar to previously published studies. Two of 25 grade II and III tumors, and 1 of 17 glioblastomas had IDH1 mutations on immunohistochemical testing. Nine cases had sufficient tissue for mutation profiling, 1 case had a BRAF V600E mutation and 2 had 2 PIK3CA mutations.


CONCLUSIONS
Survival outcomes for adult WHO Grade II to IV brainstem gliomas were similar to supratentorial IDH1 wild-type tumors of similar grade and histology. Potentially actionable mutations can be identified from small biopsy samples in a subset of adult brainstem gliomas.
Department of Neurology and John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, United States. Electronic address: btheeler@hotmail.com.
Brett J
BJ
Theeler
Department of Pathology, CHU Sainte-Justine, Universite de Montreal, 3175 Cote-Ste-Catherine Rd, Montreal, Quebec H3TIC5, Canada.
Benjamin
B
Ellezam
Neuro-Oncology Associates at Baylor Charles A. Sammons Cancer Center, 3410 Worth Street, Suite 820, Dallas, TX 75246, United States.
Isaac
I
Melguizo-Gavilanes
Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit Number: 431, Houston, TX 77030, United States.
John F
JF
de Groot
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States.
Anita
A
Mahajan
Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States.
Kenneth D
KD
Aldape
Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States.
Janet M
JM
Bruner
Division of Neuro-oncology, The Ohio State University Comprehensive Cancer Center, 320 W 10th Avenue, Starling Loving Hall Suite M410, Columbus, OH 43210, United States.
Vinay K
VK
Puduvalli
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D020295:Brain Stem Neoplasms / Q000235:genetics* / Q000401:mortality; D058534:Class I Phosphatidylinositol 3-Kinases; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005910:Glioma / Q000145:classification / Q000235:genetics* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007521:Isocitrate Dehydrogenase / Q000235:genetics* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D019869:Phosphatidylinositol 3-Kinases / Q000235:genetics; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
D007521:Isocitrate Dehydrogenase; C543588:IDH1 protein, human; D019869:Phosphatidylinositol 3-Kinases; D058534:Class I Phosphatidylinositol 3-Kinases; C484760:PIK3CA protein, human; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
Astrocytoma; Brainstem glioma; Diffuse intrinsic pontine glioma; Glioblastoma; Isocitrate dehydrogenase mutation; Oligodendroglioma