Pediatrik Beyin Sapı Glioblastomu: Tedavi Stratejileri Hakkında Sistematik Bir İnceleme

Yıl 2021, Cilt: 4 Sayı: 1, 24 - 36, 30.04.2021

Kadir Oktay Ebru Guzel Begül Yağcı-küpeli Ethem Göksu İbrahim Sarı Aslan Guzel

Öz

Beyin sapı tümörleri nadir görülen patolojilerdir, beyin sapı glioblastomu daha da nadirdir. Beyin sapı tümörleri için subtotal tümör rezeksiyonu uygulanan ve beyin sapı glioblastomu tanısı alan üç pediatrik hastayı sunmaktayız. Bu hastaların klinik gidişatlarını ve tedavi prosedürlerini, kapsamlı bir literatür taraması eşliğinde tartışmaktayız. Beyin sapında yerleşimli yüksek dereceli gliomaların tedavisinde steroidler, cerrahi rezeksiyon, radyoterapi ve kemoterapi bulunmaktadır. Bununla birlikte, bu tedavi yöntemlerinden hiçbiri hayatta kalma süresini etkili bir şekilde uzatmamaktadır. Literatüre göre, bu hastaların medyan genel sağ kalımı yaklaşık 9 ila 12 ay arasındadır. Glioblastom histopatolojisi, yüksek dereceli beyin sapı gliomaları olan pediatrik hastalarda kötü prognoz göstergesidir. Radyoterapi, uzun vadede değil ancak ilk 9 aylık süreçte mortalite riskinde azalma ile ilişkili olarak tespit edilmiştir.

Anahtar Kelimeler

Beyin sapı, Glioblastom, Pediatrik, Kemoterapi, Radyoterapi

Pediatric Brainstem Glioblastoma: A Systematic Review about Treatment Strategies

Öz

Brainstem tumors are rare pathologies, brainstem glioblastoma is even rarer. We report three pediatric patients who underwent subtotal tumor resection for brainstem tumors diagnosed as brainstem glioblastoma. The clinical courses and treatment procedures were discussed alongside a comprehensive literature review. Treatment of brainstem high-grade gliomas includes steroids, surgery, radiotherapy, and chemotherapy. However, none of these treatment modalities effectively prolongs survival time. According to literature, the median overall survival of these patients are approximately between 9 to 12 months. Glioblastoma has a poor prognosis in pediatric patients with high-grade brainstem gliomas. Radiotherapy is associated with a decreased risk of mortality at 9 months but not long-term.

Anahtar Kelimeler

Brainstem, Glioblastoma, Pediatric, Chemotherapy, Radiotherapy

Kaynakça

• Das KK, Mehrotra A, Nair AP, et al. Pediatric glioblastoma: clinico-radiological profile and factors affecting the outcome. Childs Nerv Syst. 2012;28(12):2055-2062.
• Kebudi R, Cakir FB. Management of diffuse pontine gliomas in children: recent developments. Pediatr Drugs. 2013;15(5):351-362.
• Kebudi R, Cakir FB, Yaman Agaoglu FY, Gorgun O, Ayan I, Darendeliler E. Pediatric diffuse intrinsic pontine glioma patients from a single center. Childs Nerv Syst. 2013;29(4):583-588.
• Veldhuijzen van Zanten SEM, Lane A, Heymans MW, et al. External validation of the diffuse intrinsic pontine glioma survival prediction model: a collaborative report from the International DIPG Registry and the SIOPE DIPG Registry. J Neurooncol. 2017;134(1):231-240.
• Mauffrey C. Paediatric brainstem gliomas: prognostic factors and management. J Clin Neurosci. 2006;13(4):431-437.
• Nikitovic M, Stanic D, Pekmezovic T, et al. Pediatric glioblastoma: a single institution experience. Childs Nerv Syst. 2016;32(1):97-103.
• Perkins SM, Rubin JB, Leonard JR, et al. Glioblastoma in children: a single-institution experience. Int J Radiat Oncol Biol Phys. 2011;80(4):1117-1121.
• Maxwell R, Luksik AS, Garzon-Muvdi T, et al. Population-based Study Determining Predictors of Cancer-Specific Mortality and Survival in Pediatric High-grade Brainstem Glioma. World Neurosurg. 2018;119:e1006-e1015.
• Klimo P Jr, Nesvick CL, Broniscer A, Orr BA, Choudhri AF. Malignant brainstem tumors in children, excluding diffuse intrinsic pontine gliomas. J Neurosurg Pediatr. 2016;17(1):57-65.
• Puget S, Beccaria K, Blauwblomme T, et al. Biopsy in a series of 130 pediatric diffuse intrinsic Pontine gliomas. Childs Nerv Syst. 2015;31(10):1773-1780.
• Kebudi R, Cakir FB, Bay SB, et al. Nimotuzumab-containing regimen for pediatric diffuse intrinsic pontine gliomas: a retrospective multicenter study and review of the literature. Childs Nerv Syst. 2019;35(1):83-89.
• Bailey S, Howman A, Wheatley K, et al. Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy--results of a United Kingdom phase II trial (CNS 2007 04). Eur J Cancer. 2013;49(18):3856-3862.
• Rizzo D, Scalzone M, Ruggiero A, et al. Temozolomide in the treatment of newly diagnosed diffuse brainstem glioma in children: a broken promise? J Chemother. 2015;27(2):106-110.
• Zaky W, Wellner M, Brown RJ, Blüml S, Finlay JL, Dhall G. Treatment of children with diffuse intrinsic pontine gliomas with chemoradiotherapy followed by a combination of temozolomide, irinotecan, and bevacizumab. Pediatr Hematol Oncol. 2013;30(7):623-632.
• Broniscer A, Iacono L, Chintagumpala M, et al. Role of temozolomide after radiotherapy for newly diagnosed diffuse brain stem glioma in children: results of a multiinstitutional study (SJHG-98). Cancer. 2005;103(1):133-139.
• Cohen KJ, Heideman RL, Zhou T, et al. Temozolomide in the treatment of children with newly diagnosed diffuse intrinsic pontine gliomas: a report from the Children’s Oncology Group. Neuro Oncol. 2011;13(4):410-416.
• Fleischhack G, Massimino M, Warmuth-Metz M, et al. Nimotuzumab and radiotherapy for treatment of newly diagnosed diffuse intrinsic pontine glioma (DIPG): a phase III clinical study. J Neurooncol. 2019;143(1):107-113.
• Hummel TR, Salloum R, Drissi R, et al. A pilot study of bevacizumab-based therapy in patients with newly diagnosed high-grade gliomas and diffuse intrinsic pontine gliomas. J Neurooncol. 2016;127(1):53-61.
• Jalali R, Raut N, Arora B, et al. Prospective evaluation of radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma. Int J Radiat Oncol Biol Phys. 2010;77(1):113-118.
• Janssens GO, Gidding CE, Van Lindert EJ, et al. The role of hypofractionation radiotherapy for diffuse intrinsic brainstem glioma in children: a pilot study. Int J Radiat Oncol Biol Phys. 2009;73(3):722-726.
• Kim CY, Kim SK, Phi JH, et al. A prospective study of temozolomide plus thalidomide during and after radiation therapy for pediatric diffuse pontine gliomas: preliminary results of the Korean Society for Pediatric Neuro-Oncology study. J Neurooncol. 2010;100(2):193-198.
• Kivivuori SM, Riikonen P, Valanne L, Lonnqvist T, Saarinen-Pihkala UM. Antiangiogenic combination therapy after local radiotherapy with topotecan radiosensitizer improved quality of life for children with inoperable brainstem gliomas. Acta Paediatr. 2011;100(1):134-138.
• Korones DN, Fisher PG, Kretschmar C, et al. Treatment of children with diffuse intrinsic brain stem glioma with radiotherapy, vincristine and oral VP-16: a Children’s Oncology Group phase II study. Pediatr Blood Cancer. 2008;50(2):227-230.
• Massimino M, Biassoni V, Miceli R, et al. Results of nimotuzumab and vinorelbine, radiation and re-irradiation for diffuse pontine glioma in childhood. J Neurooncol. 2014;118(2):305-312.
• Massimino M, Spreafico F, Biassoni V, et al. Diffuse pontine gliomas in children: changing strategies, changing results? A mono-institutional 20-year experience. J Neurooncol. 2008;87(3):355-361.
• Negretti L, Bouchireb K, Levy-Piedbois C, et al. Hypofractionated radiotherapy in the treatment of diffuse intrinsic pontine glioma in children: a single institution’s experience. J Neurooncol. 2011;104(3):773-777.
• Sharp JR, Bouffet E, Stempak D, et al. A multi-centre Canadian pilot study of metronomic temozolomide combined with radiotherapy for newly diagnosed paediatric brainstem glioma. Eur J Cancer. 2010;46(18):3271-3279.
• Sirachainan N, Pakakasama S, Visudithbhan A, et al. Concurrent radiotherapy with temozolomide followed by adjuvant temozolomide and cis-retinoic acid in children with diffuse intrinsic pontine glioma. Neuro Oncol. 2008;10(4):577-582.
• Wolff JE, Driever PH, Erdlenbruch B, et al. Intensive chemotherapy improves survival in pediatric high-grade glioma after gross total resection: results of the HIT-GBM-C protocol. Cancer. 2010;116(3):705-712.
• Hassan H, Pinches A, Picton SV, Phillips RS. Survival rates and prognostic predictors of high grade brain stem gliomas in childhood: a systematic review and meta-analysis. J Neurooncol. 2017;135(1):13-20.
• Khalid SI, Kelly R, Adogwa O, et al. Pediatric Brainstem Gliomas: A Retrospective Study of 180 Patients from the SEER Database. Pediatr Neurosurg. 2019;54(3):151-164.
• Lam S, Lin Y, Auffinger B, Melkonian S. Analysis of survival in pediatric high-grade brainstem gliomas: A population-based study. J Pediatr Neurosci. 2015;10(3):199-206.