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Pediatric thalamic tumors in the MRI era: a Canadian perspective

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Abstract

Background

Thalamic gliomas are rare. The natural history is unpredictable, and the optimal management of these tumors in children is poorly defined. The aim was to identify outcomes, prognostic factors, and response to various modalities of treatment in a relatively large population of pediatric thalamic tumors from many centers within a fairly homogeneous health care system.

Methods

We performed a Canadian multicenter retrospective review of pediatric thalamic tumors presenting during the MRI era (1989–2012). Radiology and pathology were reviewed by central independent reviewers. Paraffin shavings for RNA extraction were taken and tested for fusion events involving KIAA1549:BRAF. Tumors were classified as unilateral or bithalamic based on their origin on imaging. Univariate and multivariate analyses on factors influencing survival were performed.

Results

Seventy-two thalamic tumors were identified from 11 institutions. Females represented 53 % of the study population, and the mean age at presentation was 8.9 years. Sixty-two tumors were unilateral and 10 bithalamic. Unilateral tumors had a greater propensity to grow inferiorly towards the brainstem. These tumors were predominantly low grade in comparison to bithalamic tumors which were high-grade astrocytomas. The 5-year overall survival was 61 ± 13 % for unithalamic tumors compared to 37 ± 32 % for bithalamic tumors (p = 0.097). Multivariate analysis indicated tumor grade as the only significant prognostic factor for unithalamic tumors. Six unilateral tumors, all low grade, were BRAF fusion positive.

Conclusion

Unilateral and bilateral thalamic tumors behave differently. Surgical resection is an appropriate treatment option in unilateral tumors, most of which are low grade, but outcome is not related to extent of resection (EOR). Bilateral thalamic tumors have a poorer prognosis, but the occasional patient does remarkably well. The efficacy of chemotherapy and radiotherapy has not been clearly demonstrated. Novel therapeutic approaches are required to improve the prognosis for malignant unilateral thalamic tumors and bilateral thalamic tumors.

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Author information

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia & British Columbia Children’s Hospital, 4480 Oak St., Room K3-159, V6H 3V4, Vancouver, BC, Canada

    Paul Steinbok, Chittur Viswanathan Gopalakrishnan & Alexander R. Hengel

  2. Division of Neurosurgery, Royal University Hospital, Saskatoon, SK, Canada

    Aleksander M. Vitali

  3. Department of Radiology, University of British Columbia & British Columbia Children’s Hospital, Vancouver, BC, Canada

    Ken Poskitt

  4. Division of Pathology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Cynthia Hawkins

  5. Division of Pediatric Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    James Drake & Maria Lamberti-Pasculli

  6. Division of Neurosurgery, McMaster Children’s Hospital, Hamilton, ON, Canada

    Olufemi Ajani

  7. Division of Neurosurgery, Alberta Children’s Hospital, Calgary, AB, Canada

    Walter Hader

  8. Division of Neurosurgery, Stollery Children’s Hospital, Edmonton, AB, Canada

    Vivek Mehta

  9. Division of Neurosurgery, IWK Health Centre, Halifax, NS, Canada

    P. Daniel McNeely

  10. Section of Neurosurgery, Winnipeg’s Children’s Hospital, Winnipeg, MB, Canada

    Patrick J. McDonald

  11. Division of Neurosurgery, Children’s Hospital, London Health Sciences Center, London, ON, Canada

    Adrianna Ranger

  12. Division of Neurosurgery, University of Ottawa & Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Michael Vassilyadi

  13. Division of Paediatric Neurosurgery, McGill University Health Centre, Montreal, QC, Canada

    Jeff Atkinson

  14. The Arthur and Sonia Labatt Brain Tumour Research Centre, the Hospital for Sick Children, Toronto, ON, Canada

    Scott Ryall

  15. Division of Hematology, Oncology and Palliative Care, Department of Pediatrics, University of Alberta & Stollery Children’s Hospital, Edmonton, AB, Canada

    David D. Eisenstat

  16. Division of Neurology and Oncology, Department of Pediatrics, University of British Columbia & British Columbia Children’s Hospital, Vancouver, BC, Canada

    Juliette Hukin

Authors
  1. Paul Steinbok
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  2. Chittur Viswanathan Gopalakrishnan
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  8. Maria Lamberti-Pasculli
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  9. Olufemi Ajani
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  10. Walter Hader
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  12. P. Daniel McNeely
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  13. Patrick J. McDonald
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  14. Adrianna Ranger
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  15. Michael Vassilyadi
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  16. Jeff Atkinson
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  18. David D. Eisenstat
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  19. Juliette Hukin
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Corresponding author

Correspondence to Paul Steinbok.

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Funding

Financial support was provided by the following organizations:

  • C17 Research Network in partnership with the Childhood Cancer Canada Foundation and the Coast-to-Coast Against Cancer Foundation.

  • Brain Tumor Foundation of Canada

Conflict of interest

The authors have nothing to disclose.

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Steinbok, P., Gopalakrishnan, C.V., Hengel, A.R. et al. Pediatric thalamic tumors in the MRI era: a Canadian perspective. Childs Nerv Syst 32, 269–280 (2016). https://doi.org/10.1007/s00381-015-2968-z

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  • DOI: https://doi.org/10.1007/s00381-015-2968-z

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