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High-Grade Glioma

  • Scheryll Alken
  • Fernando Carceller
  • Henry Mandeville
  • Frank SaranEmail author
Chapter

Abstract

High-grade gliomas are defined as tumors of glial origin with a very low incidence rate in infants and young children. They form part of the spectrum of primary intrinsic CNS and spinal cord tumors of children although their proportionate frequency of all primary CNS and spinal cord tumors is significantly lower compared to the adult population. The overwhelming number of newly diagnosed cases are sporadic primary tumors presenting with either signs of raised intracranial pressure, seizures, or other more nonspecific neurological symptoms. The initial management is aimed at restoring CSF flow, alleviation of existing mass effect, and establishing a pathological diagnosis. Ideally, the primary surgical approach is aimed at achieving a macroscopic complete excision without postoperative severe and permanent neurologic deficits. While primary chemotherapy is the preferred mode of adjuvant treatment in infants under the age of 3 years, the standard of care in all other patients is the use of combined focal radiotherapy and chemotherapy. Long-term outcome remains poor albeit appears generally slightly better than their adult counterparts.

References

  1. Alonso M, Hamelin R, Kim M et al (2001) Microsatellite instability occurs in distinct subtypes of pediatric but not adult central nervous system tumors. Cancer Res 61:2124–2128PubMedGoogle Scholar
  2. Armstrong GT, Jain N, Liu W et al (2010) Region-specific radiotherapy and neuropsychological outcomes in adult survivors of childhood CNS malignancies. Neuro Oncol 12:1173–1186. doi: 10.1093/neuonc/noq104 CrossRefPubMedPubMedCentralGoogle Scholar
  3. Barrow J, Adamowicz-Brice M, Cartmill M et al (2011) Homozygous loss of ADAM3A revealed by genome-wide analysis of pediatric high-grade glioma and diffuse intrinsic pontine gliomas. Neuro Oncol 13:212–222. doi: 10.1093/neuonc/noq158 CrossRefPubMedGoogle Scholar
  4. Batra V, Sands SA, Holmes E et al (2014) Long-term survival of children less than six years of age enrolled on the CCG-945 phase III trial for newly-diagnosed high-grade glioma: a report from the Children’s Oncology Group. Pediatr Blood Cancer 61:151–157. doi: 10.1002/pbc.24718 CrossRefPubMedGoogle Scholar
  5. Bax DA, Mackay A, Little SE et al (2010) A distinct spectrum of copy number aberrations in pediatric high-grade gliomas. Clin Cancer Res 16:3368–3377. doi: 10.1158/1078-0432.CCR-10-0438 CrossRefPubMedPubMedCentralGoogle Scholar
  6. Bender S, Tang Y, Lindroth AM et al (2013) Reduced H3K27me3 and DNA hypomethylation are major drivers of gene expression in K27M mutant pediatric high-grade gliomas. Cancer Cell 24:660–672. doi: 10.1016/j.ccr.2013.10.006 CrossRefPubMedGoogle Scholar
  7. van den Bent MJ (2007) Anaplastic oligodendroglioma and oligoastrocytoma. Neurol Clin 25:1089–1109., ix–x. doi: 10.1016/j.ncl.2007.07.013 CrossRefPubMedGoogle Scholar
  8. Bhandare N, Jackson A, Eisbruch A et al (2010) Radiation therapy and hearing loss. Int J Radiat Oncol Biol Phys 76:S50–S57. doi: 10.1016/j.ijrobp.2009.04.096 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Bloom HJ (1975) Combined modality therapy for intracranial tumors. Cancer 35:111–120CrossRefPubMedGoogle Scholar
  10. Bloom HJ, Bessell EM (1990) Medulloblastoma in adults: a review of 47 patients treated between 1952 and 1981. Int J Radiat Oncol Biol Phys 18:763–772CrossRefPubMedGoogle Scholar
  11. Bloom HJ, Glees J, Bell J et al (1990) The treatment and long-term prognosis of children with intracranial tumors: a study of 610 cases, 1950–1981. Int J Radiat Oncol Biol Phys 18:723–745CrossRefPubMedGoogle Scholar
  12. Boyett J, Yates A, Gilles F, Burger P (1998) When is a high-grade astrocytoma (HGA) not a HGA? Results of a central review of 226 cases of anaplastic astrocytoma (AA), glioblastoma multiforme (GBM), and other-HGA (OTH-HGA) by five neuropathologists. Proc Am Soc Clin Oncol 17:526aGoogle Scholar
  13. Bredel M, Pollack IF, Hamilton RL, James CD (1999) Epidermal growth factor receptor expression and gene amplification in high-grade non-brainstem gliomas of childhood. Clin Cancer Res 5:1786–1792PubMedGoogle Scholar
  14. Broniscer A, Gajjar A (2004) Supratentorial high-grade astrocytoma and diffuse brainstem glioma: two challenges for the pediatric oncologist. Oncologist 9:197–206CrossRefPubMedGoogle Scholar
  15. Campbell JW, Pollack IF, Martinez AJ, Shultz B (1996) High-grade astrocytomas in children: radiologically complete resection is associated with an excellent long-term prognosis. Neurosurgery 38:258–264CrossRefPubMedGoogle Scholar
  16. Carret A-S, Tabori U, Crooks B et al (2006) Outcome of secondary high-grade glioma in children previously treated for a malignant condition: a study of the Canadian Pediatric Brain Tumour Consortium. Radiother Oncol 81:33–38. doi: 10.1016/j.radonc.2006.08.005 CrossRefPubMedGoogle Scholar
  17. Chemaitilly W, Li Z, Huang S et al (2015) Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: a report from the St Jude Lifetime Cohort study. J Clin Oncol 33:492–500. doi: 10.1200/JCO.2014.56.7933 CrossRefPubMedPubMedCentralGoogle Scholar
  18. Cohen KJ, Heideman RL, Zhou T et al (2011) Temozolomide in the treatment of children with newly diagnosed diffuse intrinsic pontine gliomas: a report from the Children’s Oncology Group. Neuro Oncol 13:410–416. doi: 10.1093/neuonc/noq205 CrossRefPubMedPubMedCentralGoogle Scholar
  19. De Carli E, Wang X, Puget S (2009) IDH1 and IDH2 mutations in gliomas. N Engl J Med 360:2248.; author reply 2249. doi: 10.1056/NEJMc090593 CrossRefPubMedGoogle Scholar
  20. Donahue B, Scott CB, Nelson JS et al (1997) Influence of an oligodendroglial component on the survival of patients with anaplastic astrocytomas: a report of Radiation Therapy Oncology Group 83-02. Int J Radiat Oncol Biol Phys 38:911–914CrossRefPubMedGoogle Scholar
  21. Duffner PK, Cohen ME, Thomas PR, Lansky SB (1985) The long-term effects of cranial irradiation on the central nervous system. Cancer 56:1841–1846CrossRefPubMedGoogle Scholar
  22. Duffner PK, Horowitz ME, Krischer JP et al (1993) Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. N Engl J Med 328:1725–1731. doi: 10.1056/NEJM199306173282401 CrossRefPubMedGoogle Scholar
  23. Duffner PK, Krischer JP, Burger PC et al (1996) Treatment of infants with malignant gliomas: the Pediatric Oncology Group experience. J Neurooncol 28:245–256CrossRefPubMedGoogle Scholar
  24. Dufour C, Grill J, Lellouch-Tubiana A et al (2006) High-grade glioma in children under 5 years of age: a chemotherapy only approach with the BBSFOP protocol. Eur J Cancer 42:2939–2945. doi: 10.1016/j.ejca.2006.06.021 CrossRefPubMedGoogle Scholar
  25. Ellenberg L, McComb JG, Siegel SE, Stowe S (1987) Factors affecting intellectual outcome in pediatric brain tumor patients. Neurosurgery 21:638–644CrossRefPubMedGoogle Scholar
  26. Fallai C, Olmi P (1997) Hyperfractionated and accelerated radiation therapy in central nervous system tumors (malignant gliomas, pediatric tumors, and brain metastases). Radiother Oncol 43:235–246CrossRefPubMedGoogle Scholar
  27. Fangusaro J (2009) Pediatric high-grade gliomas and diffuse intrinsic pontine gliomas. J Child Neurol 24:1409–1417. doi: 10.1177/0883073809338960 CrossRefPubMedGoogle Scholar
  28. Fangusaro J (2012) Pediatric high grade glioma: a review and update on tumor clinical characteristics and biology. Front Oncol 2:105. doi: 10.3389/fonc.2012.00105 CrossRefPubMedPubMedCentralGoogle Scholar
  29. Finlay JL, Boyett JM, Yates AJ et al (1995) Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimen. Childrens Cancer Group. J Clin Oncol 13:112–123CrossRefPubMedGoogle Scholar
  30. Fitzek MM, Thornton AF, Rabinov JD et al (1999) Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme: results of a phase II prospective trial. J Neurosurg 91:251–260. doi: 10.3171/jns.1999.91.2.0251 CrossRefPubMedGoogle Scholar
  31. Fulton DS, Urtasun RC, Scott-Brown I et al (1992) Increasing radiation dose intensity using hyperfractionation in patients with malignant glioma. Final report of a prospective phase I-II dose response study. J Neurooncol 14:63–72CrossRefPubMedGoogle Scholar
  32. Geyer JR, Finlay JL, Boyett JM et al (1995) Survival of infants with malignant astrocytomas. A report from the Childrens Cancer Group. Cancer 75:1045–1050CrossRefPubMedGoogle Scholar
  33. Glauser TA, Packer RJ (1991) Cognitive deficits in long-term survivors of childhood brain tumors. Childs Nerv Syst 7:2–12CrossRefPubMedGoogle Scholar
  34. Gorlia T, van den Bent MJ, Hegi ME et al (2008) Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol 9:29–38. doi: 10.1016/S1470-2045(07)70384-4 CrossRefPubMedGoogle Scholar
  35. Grabowski MM, Recinos PF, Nowacki AS et al (2014) Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg 121:1–9. doi: 10.3171/2014.7.JNS132449 CrossRefGoogle Scholar
  36. Jalali R, Rishi A, Goda JS et al (2015) Clinical outcome and molecular characterization of pediatric glioblastoma treated with postoperative radiotherapy with concurrent and adjuvant temozolomide: a single institutional study of 66 children. Neuro-Oncol Pract 3(1):39–47. doi: 10.1093/nop/npv024 Google Scholar
  37. Jannoun L, Bloom HJ (1990) Long-term psychological effects in children treated for intracranial tumors. Int J Radiat Oncol Biol Phys 18:747–753CrossRefPubMedGoogle Scholar
  38. Jeibmann A, Hasselblatt M, Pfister S et al (2009) From glioblastoma to gangliocytoma: an unforeseen but welcome shift in biological behavior. J Neurosurg Pediatr 4:475–478. doi: 10.3171/2009.6.PEDS097 CrossRefPubMedGoogle Scholar
  39. Kaatsch P, Rickert CH, Kühl J et al (2001) Population-based epidemiologic data on brain tumors in German children. Cancer 92:3155–3164CrossRefPubMedGoogle Scholar
  40. Kandasamy J, Dwan K, Hartley JC et al (2011) Antibiotic-impregnated ventriculoperitoneal shunts—a multi-centre British paediatric neurosurgery group (BPNG) study using historical controls. Childs Nerv Syst 27:575–581. doi: 10.1007/s00381-010-1290-z CrossRefPubMedGoogle Scholar
  41. Kirkpatrick JP, van der Kogel AJ, Schultheiss TE (2010) Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76:S42–S49. doi: 10.1016/j.ijrobp.2009.04.095 CrossRefPubMedGoogle Scholar
  42. Lawrence YR, Li XA, el Naqa I et al (2010) Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys 76:S20–S27. doi: 10.1016/j.ijrobp.2009.02.091 CrossRefPubMedPubMedCentralGoogle Scholar
  43. Leung SY, Chan TL, Chung LP et al (1998) Microsatellite instability and mutation of DNA mismatch repair genes in gliomas. Am J Pathol 153:1181–1188. doi: 10.1016/S0002-9440(10)65662-3 CrossRefPubMedPubMedCentralGoogle Scholar
  44. Louis DN, Ohgaki H, Wiestler OD et al (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109. doi: 10.1007/s00401-007-0243-4 CrossRefPubMedPubMedCentralGoogle Scholar
  45. MacDonald TJ, Aguilera D, Kramm CM (2011) Treatment of high-grade glioma in children and adolescents. Neuro Oncol 13:1049–1058. doi: 10.1093/neuonc/nor092 CrossRefPubMedPubMedCentralGoogle Scholar
  46. Marchese MJ, Chang CH (1990) Malignant astrocytic gliomas in children. Cancer 65:2771–2778CrossRefPubMedGoogle Scholar
  47. Mayo C, Martel MK, Marks LB et al (2010) Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Oncol Biol Phys 76:S28–S35. doi: 10.1016/j.ijrobp.2009.07.1753 CrossRefPubMedGoogle Scholar
  48. McAllister B, Archambeau JO, Nguyen MC, Slater JD, Loredo L, Schulte R, Alvarez O, Bedros AA, Kaleita T, Moyers M, Miller D, Slater JM. Proton therapy for pediatric cranial tumors: preliminary report on treatment and disease-related morbidities. Int J Radiat Oncol Biol Phys. 1997;39(2):455–60Google Scholar
  49. McKean-Cowdin R, Razavi P, Barrington-Trimis J et al (2013) Trends in childhood brain tumor incidence, 1973–2009. J Neurooncol 115:153–160. doi: 10.1007/s11060-013-1212-5 CrossRefPubMedPubMedCentralGoogle Scholar
  50. Melean G, Sestini R, Ammannati F, Papi L (2004) Genetic insights into familial tumors of the nervous system. Am J Med Genet C Semin Med Genet 129C:74–84. doi: 10.1002/ajmg.c.30022 CrossRefPubMedGoogle Scholar
  51. Merchant TE, Chitti RM, Li C et al (2010) Factors associated with neurological recovery of brainstem function following postoperative conformal radiation therapy for infratentorial ependymoma. Int J Radiat Oncol Biol Phys 76:496–503. doi: 10.1016/j.ijrobp.2009.01.079 CrossRefPubMedGoogle Scholar
  52. Miele E, Buttarelli FR, Arcella A et al (2014) High-throughput microRNA profiling of pediatric high-grade gliomas. Neuro Oncol 16:228–240. doi: 10.1093/neuonc/not215 CrossRefPubMedGoogle Scholar
  53. Mulhern RK, Kovnar E, Langston J et al (1992) Long-term survivors of leukemia treated in infancy: factors associated with neuropsychologic status. J Clin Oncol 10:1095–1102CrossRefPubMedGoogle Scholar
  54. Niyazi M, Brada M, Chalmers AJ et al (2016) ESTRO-ACROP guideline “target delineation of glioblastomas”. Radiother Oncol 118:35–42. doi: 10.1016/j.radonc.2015.12.003 CrossRefPubMedGoogle Scholar
  55. Ostrom QT, Gittleman H, Liao P et al (2014) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007–2011. Neuro Oncol 16(Suppl 4):iv1–iv63. doi: 10.1093/neuonc/nou223 CrossRefPubMedPubMedCentralGoogle Scholar
  56. Packer RJ, Sutton LN, Atkins TE et al (1989) A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results. J Neurosurg 70:707–713. doi: 10.3171/jns.1989.70.5.0707 CrossRefPubMedGoogle Scholar
  57. Packer RJ, Zimmerman RA, Kaplan A et al (1993) Early cystic/necrotic changes after hyperfractionated radiation therapy in children with brain stem gliomas. Data from the Childrens Cancer Group. Cancer 71:2666–2674CrossRefPubMedGoogle Scholar
  58. Panigrahy A, Blüml S (2009) Neuroimaging of pediatric brain tumors: from basic to advanced magnetic resonance imaging (MRI). J Child Neurol 24:1343–1365. doi: 10.1177/0883073809342129 CrossRefPubMedGoogle Scholar
  59. Paugh BS, Qu C, Jones C et al (2010) Integrated molecular genetic profiling of pediatric high-grade gliomas reveals key differences with the adult disease. J Clin Oncol 28:3061–3068. doi: 10.1200/JCO.2009.26.7252 CrossRefPubMedPubMedCentralGoogle Scholar
  60. Peet AC, Arvanitis TN, Leach MO, Waldman AD (2012) Functional imaging in adult and paediatric brain tumours. Nat Rev Clin Oncol 9:700–711. doi: 10.1038/nrclinonc.2012.187 CrossRefPubMedGoogle Scholar
  61. Phuphanich S, Edwards MS, Levin VA et al (1984) Supratentorial malignant gliomas of childhood. Results of treatment with radiation therapy and chemotherapy. J Neurosurg 60:495–499. doi: 10.3171/jns.1984.60.3.0495 CrossRefPubMedGoogle Scholar
  62. Pollack IF (1994) Brain tumors in children. N Engl J Med 331:1500–1507. doi: 10.1056/NEJM199412013312207 CrossRefPubMedGoogle Scholar
  63. Pollack IF, Finkelstein SD, Woods J et al (2002) Expression of p53 and prognosis in children with malignant gliomas. N Engl J Med 346:420–427. doi: 10.1056/NEJMoa012224 CrossRefPubMedGoogle Scholar
  64. Pollack IF, Hamilton RL, James CD et al (2006) Rarity of PTEN deletions and EGFR amplification in malignant gliomas of childhood: results from the Children’s Cancer Group 945 cohort. J Neurosurg 105:418–424. doi: 10.3171/ped.2006.105.5.418 CrossRefPubMedGoogle Scholar
  65. Pollack IF, Hamilton RL, Sobol RW et al (2011) IDH1 mutations are common in malignant gliomas arising in adolescents: a report from the Children’s Oncology Group. Childs Nerv Syst 27:87–94. doi: 10.1007/s00381-010-1264-1 CrossRefPubMedGoogle Scholar
  66. Qu H-Q, Jacob K, Fatet S et al (2010) Genome-wide profiling using single-nucleotide polymorphism arrays identifies novel chromosomal imbalances in pediatric glioblastomas. Neuro Oncol 12:153–163. doi: 10.1093/neuonc/nop001 CrossRefPubMedPubMedCentralGoogle Scholar
  67. Reddy AT, Wellons JC (2003) Pediatric high-grade gliomas. Cancer J 9:107–112CrossRefPubMedGoogle Scholar
  68. Relling MV, Rubnitz JE, Rivera GK et al (1999) High incidence of secondary brain tumours after radiotherapy and antimetabolites. Lancet 354:34–39. doi: 10.1016/S0140-6736(98)11079-6 CrossRefPubMedGoogle Scholar
  69. Reulecke BC, Erker CG, Fiedler BJ et al (2008) Brain tumors in children: initial symptoms and their influence on the time span between symptom onset and diagnosis. J Child Neurol 23:178–183. doi: 10.1177/0883073807308692 CrossRefPubMedGoogle Scholar
  70. Rickert CH, Sträter R, Kaatsch P et al (2001) Pediatric high-grade astrocytomas show chromosomal imbalances distinct from adult cases. Am J Pathol 158:1525–1532. doi: 10.1016/S0002-9440(10)64103-X CrossRefPubMedPubMedCentralGoogle Scholar
  71. Roth P, Regli L, Tonder M, Weller M (2013) Tumor-associated edema in brain cancer patients: pathogenesis and management. Expert Rev Anticancer Ther 13:1319–1325. doi: 10.1586/14737140.2013.852473 CrossRefPubMedGoogle Scholar
  72. Rutkowski S, Bode U, Deinlein F et al (2005) Treatment of early childhood medulloblastoma by postoperative chemotherapy alone. N Engl J Med 352:978–986. doi: 10.1056/NEJMoa042176 CrossRefPubMedGoogle Scholar
  73. Schwartzentruber J, Korshunov A, Liu X-Y et al (2012) Driver mutations in histone H3.3 and chromatin remodelling genes in paediatric glioblastoma. Nature 482:226–231. doi: 10.1038/nature10833 CrossRefPubMedGoogle Scholar
  74. Sposto R, Ertel IJ, Jenkin RD et al (1989) The effectiveness of chemotherapy for treatment of high grade astrocytoma in children: results of a randomized trial. A report from the Childrens Cancer Study Group. J Neurooncol 7:165–177CrossRefPubMedGoogle Scholar
  75. Stummer W, Rodrigues F, Schucht P et al (2014) Predicting the “usefulness” of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey. Acta Neurochir 156:2315–2324. doi: 10.1007/s00701-014-2234-2 CrossRefPubMedPubMedCentralGoogle Scholar
  76. Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. doi: 10.1056/NEJMoa043330 CrossRefPubMedGoogle Scholar
  77. Sturm D, Witt H, Hovestadt V et al (2012) Hotspot mutations in H3F3A and IDH1 define distinct epigenetic and biological subgroups of glioblastoma. Cancer Cell 22:425–437. doi: 10.1016/j.ccr.2012.08.024 CrossRefPubMedGoogle Scholar
  78. Sturm D, Bender S, Jones DTW et al (2014) Paediatric and adult glioblastoma: multiform (epi)genomic culprits emerge. Nat Rev Cancer 14:92–107. doi:  10.1038/nrc3655
  79. Sung T, Miller DC, Hayes RL et al (2000) Preferential inactivation of the p53 tumor suppressor pathway and lack of EGFR amplification distinguish de novo high grade pediatric astrocytomas from de novo adult astrocytomas. Brain Pathol 10:249–259CrossRefPubMedGoogle Scholar
  80. Vern-Gross TZ1, Schreiber JE1, Broniscer A1, Wu S1, Xiong X1, Merchant TE1. Prospective evaluation of local control and late effects of conformal radiation therapy in children, adolescents, and young adults with high-grade glioma. Neuro Oncol. 2014;16(12):1652–60Google Scholar
  81. Walker MD, Alexander E, Hunt WE et al (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:333–343. doi: 10.3171/jns.1978.49.3.0333 CrossRefPubMedGoogle Scholar
  82. Werner-Wasik M, Scott CB, Nelson DF et al (1996) Final report of a phase I/II trial of hyperfractionated and accelerated hyperfractionated radiation therapy with carmustine for adults with supratentorial malignant gliomas. Radiation Therapy Oncology Group Study 83-02. Cancer 77:1535–1543. doi: 10.1002/(SICI)1097-0142(19960415)77:8<1535::AID-CNCR17>3.0.CO;2-0 CrossRefPubMedGoogle Scholar
  83. Wisoff JH, Boyett JM, Berger MS et al (1998) Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children’s Cancer Group trial no. CCG-945. J Neurosurg 89:52–59. doi: 10.3171/jns.1998.89.1.0052 CrossRefPubMedGoogle Scholar
  84. Wolff JEA, Gnekow AK, Kortmann RD et al (2002) Preradiation chemotherapy for pediatric patients with high-grade glioma. Cancer 94:264–271. doi: 10.1002/cncr.10114 CrossRefPubMedGoogle Scholar
  85. Wolff JEA, Driever PH, Erdlenbruch B et al (2010) Intensive chemotherapy improves survival in pediatric high-grade glioma after gross total resection: results of the HIT-GBM-C protocol. Cancer 116:705–712. doi: 10.1002/cncr.24730 CrossRefPubMedGoogle Scholar
  86. Wong T-T, Liang M-L, Chen H-H, Chang F-C (2011) Hydrocephalus with brain tumors in children. Childs Nerv Syst 27:1723–1734. doi: 10.1007/s00381-011-1523-9 CrossRefPubMedGoogle Scholar
  87. Wu G, Diaz AK, Paugh BS et al (2014) The genomic landscape of diffuse intrinsic pontine glioma and pediatric non-brainstem high-grade glioma. Nat Genet 46:444–450. doi: 10.1038/ng.2938 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Scheryll Alken
    • 1
  • Fernando Carceller
    • 1
  • Henry Mandeville
    • 1
  • Frank Saran
    • 2
    Email author
  1. 1.Department of Paediatric Oncology and Neuro-OncologyThe Royal Marsden Hospital NHS Foundation TrustSuttonUK
  2. 2.Department of Paediatric OncologyThe Royal Marsden Hospital NHS Foundation TrustSuttonUK

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