Central Nervous System
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): Brainstem glioma (BSG) is an aggressive and rare tumor of childhood and adults. Treatment outcomes are dismal and role of concurrent chemoradiotherapy (CTRT) is not established in these patients .We intended to study the clinical characteristics along with outcome of BSG patients treated with CTRT at our institution.
Materials/Methods: We retrospectively evaluated 71 patients of all age groups with BSG treated at our department in the period January 2015 to October 2017. Demographic and disease characteristics in this patient cohort were recorded, and their progression free survival (PFS) was analyzed with respect to age (> 18 years), gender, grade, use of CTRT and adjuvant chemotherapy.
Results: Median age at presentation was 15 years (range 3-66 years), with a male: female ratio of 1.5. 31 patients presented with gait ataxia and 29 presented with cranial nerve palsies. 34 patients were diagnosed radiologically as high grade, 32 as low grade and grade was equivocal in 5 patients. None of the patient underwent surgery. Radiotherapy dose was 56-60 Gray over 5.5 -6 weeks at 1.8-2 gray/fraction. All patients completed their radiotherapy except 7 patients.28 patients received concurrent Temozolomide (75 mg/m2) ,17 patients received adjuvant Temozolomide (150-200 mg/m2 D1-5 every 4 weeks for 3-6 cycles) and 9 patient received both concurrent and adjuvant Temozolomide. Median follow up duration was 23.2 months (range 8-65.3 months).At last follow up, 21 patients had progressive disease. Median PFS for the entire group was 16.7 months and PFS at 24 months and 36 months was 75% and 65% respectively. On univariate analysis, patients less than 18 years had poorer outcome as compared to older (Median PFS 9.5 vs. 41.32 months; p 0.004) and PFS was significantly poorer in the patients who received concurrent Temozolomide than those who did not (Median PFS 9.8 vs. 21.5 months; p 0.05).Gender, grade and adjuvant chemotherapy did not statistically alter treatment outcomes. Age less than 18 years continued to be statistically significant on multivariate Analysis (p .01)
Conclusion: Younger age appears to be a bad prognostic factor for BSG patients. Temozolomide has a questionable role to play in the treatment of these patients.
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