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J Child Neurol. 2017 Feb;32(2):194-203. doi: 10.1177/0883073816675547. Epub 2016 Nov 3.

Brainstem Low-Grade Gliomas in Children-Excellent Outcomes With Multimodality Therapy.

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1 Department of Oncology, Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
2 Department of Pediatrics, Division of Pediatric Hematology Oncology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
3 Department of Neurosurgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
5 Texas Center for Proton Therapy, Irving, TX, USA.
6 Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
7 Departments of Pediatrics and Neurology, Division of Pediatric Neurology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.


Safe maximal surgical resection is the initial treatment of choice for pediatric brainstem low-grade gliomas. Optimal therapy for incompletely resected tumors or that progress after surgery is uncertain. We reviewed the clinical characteristics, therapy, and outcomes of all children with nontectal brainstem low-grade gliomas treated at the University of Michigan between 1993 and 2013. Median age at diagnosis was 6 years; histology was confirmed in 23 of 25 tumors, 64% were pilocytic astrocytoma. Nineteen patients underwent initial tumor resection; 14/19 received no upfront adjuvant therapy. Eight patients in the study had progressive disease; 5 initially resected tumors received chemotherapy at tumor relapse, all with partial or complete radiographic responses. Ten-year progression-free survival is 71% and overall survival, 100%. This single-institution retrospective study demonstrates excellent survival rates for children with brainstem low-grade gliomas. The efficacy of the well-tolerated chemotherapy in this series supports its role in the treatment of unresectable or progressive brainstem low-grade gliomas.


brainstem tumors; chemotherapy; low-grade glioma; overall survival; progressive tumors

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