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National trends in the treatment of adult diffuse midline gliomas: a rare clinical scenario

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Abstract

Purpose

Diffuse midline gliomas (DMG) include all midline gliomas with a point mutation to the histone H3 gene resulting in the substitution of a lysine with a methionine (K27M). These tumors are classified as World Health Organization grade 4 with a mean survival between 9- and 19-months following diagnosis. There is currently no standard of care for DMG, and palliative radiation therapy has been proven to only extend survival by months. Our current study aims to report current treatment trends and predictors of the overall survival of DMG.

Methods

We searched the National Cancer Database for adult patients treated for DMG from 2016 to 2020. Patients were required to have been treated with primary radiation directed at the brain with or without concurrent chemotherapy. Univariable and multivariable Cox regressions were used to determine predictors of overall survival.

Results

Of the 131 patients meeting the inclusion criteria, 113 (86%) received radiation and chemotherapy. Based on multivariable Cox regression, significant predictors of survival were Charlson-Deyo comorbidity index and race. Patients with a Charlson-Deyo score of 1 had 2.72 times higher odds of mortality than those with a score of 0. Patients not identifying as White or Black had 2.67 times higher odds of mortality than those identifying as White. The median survival for all patients was 19 months.

Conclusions

Despite being considered ineffective, chemotherapy is still administered in most adult patients diagnosed with DMG. Significant predictors of survival were Charlson-Deyo comorbidity index and race.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The authors thank Sarah Carey, MS, Jade Chang, and Jacalyn Newman, PhD, of Allegheny Health Network’s Health System Publication Support Office (HSPSO) for their assistance in editing and formatting the manuscript. The HSPSO is funded by Highmark Health (Pittsburgh, PA, United States of America) and all work was done in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, USA

    Jay Desai & Sujay Rajkumar

  2. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA

    Stephen M. Karlovits, Zachary D. Horne & Rodney E. Wegner

  3. Department of Neurosurgery, Allegheny Health Network, Pittsburgh, USA

    Matthew J. Shepard

  4. Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA

    John Herbst

  5. New York Proton Center, New York, USA

    Shakir Hasan

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  1. Jay Desai
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jay Desai, Sujay Rajkumar and Rodney Wegner. The first draft of the manuscript was written by Jay Desai and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rodney E. Wegner.

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The authors declare no competing interests.

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This retrospective study used de-identified data from the NCDB and was therefore except from Institutional Review Board review.

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Desai, J., Rajkumar, S., Shepard, M.J. et al. National trends in the treatment of adult diffuse midline gliomas: a rare clinical scenario. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04663-w

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