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Incidence and patterns of neuraxis metastases in children with diffuse pontine glioma★

  • Clinical-patient studies
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Summary

Purpose

We performed a retrospective study of patients with diffuse pontine glioma (DPG) who suffered neuraxis metastasis (NM) and characterized the incidence, clinical features, radiologic findings, and patterns of disease dissemination.

Methods

Magnetic resonance imaging (MRI) of brain and spine was used to assess NM. Some patients also underwent magnetic resonance spectroscopy (MRS) (6 patients) and fluorodeoxyglucose positron emission tomography (FDG-PET) scans (13 patients) to further evaluate areas of metastatic disease. Three patients had histologic confirmation of disease at the site of NM.

Results

Between 1986 and 2003, 18 of 96 patients (17.3%) with DPG developed NM. The median age at diagnosis was 8 years (range, 4–17). All patients had adjuvant chemotherapy and/or focal radiotherapy at diagnosis. The NM occurred at a median of 15 months from diagnosis of DPG (range, 3–96). Three patterns of NM were seen on MRI of brain and spine in these patients; 8 (39%) had parenchymal (PM), 4 (22%) leptomeningeal (PM), 2 (11%) subependymal, and in 5 a combination of two or more patterns. The MRS and FDG-PET scan of suspected areas of metastatic disease was consistent with tumor in 6 of 6 and 12 of 13 patients who underwent these procedures respectively. Three patients also had histologic confirmation of malignant glioma at the site of NM. Despite salvage therapy, all 18 patients have died of disease at a median of 5 months (range, 0.5–20) from diagnosis of neuraxis spread.

Conclusion

Our study emphasizes the need for screening patients with DPG for NM at the time of recurrence.

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Authors and Affiliations

  1. The Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC 27710, USA

    Sridharan Gururangan, Colleen A. McLaughlin, Melody A. Watral, Jennifer Quinn, David Reardon, James Vredenburgh, Allan Friedman & Henry S. Friedman

  2. Departments of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA

    Sridharan Gururangan & David Reardon

  3. Department of Radiation-Oncology, Duke University Medical Center, Durham, NC 27710, USA

    James Brashears & Edward C. Halperin

  4. Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA

    James Provenzale & R. Edward Coleman

  5. Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA

    Jennifer Quinn & James Vredenburgh

  6. Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA

    Allan Friedman & Henry S. Friedman

  7. The Brain Tumor Center at Duke and Departments of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA

    Sridharan Gururangan

Authors
  1. Sridharan Gururangan
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  2. Colleen A. McLaughlin
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  3. James Brashears
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  4. Melody A. Watral
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  5. James Provenzale
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  6. R. Edward Coleman
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  7. Edward C. Halperin
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  8. Jennifer Quinn
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  9. David Reardon
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  10. James Vredenburgh
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  11. Allan Friedman
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  12. Henry S. Friedman
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Corresponding author

Correspondence to Sridharan Gururangan.

Additional information

★Presented in part at the International Society of Pediatric Neuro-Oncology Meeting held in Boston, MA June 13–16, 2004.

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Gururangan, S., McLaughlin, C.A., Brashears, J. et al. Incidence and patterns of neuraxis metastases in children with diffuse pontine glioma★ . J Neurooncol 77, 207–212 (2006). https://doi.org/10.1007/s11060-005-9029-5

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  • DOI: https://doi.org/10.1007/s11060-005-9029-5

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