Original Article
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 10, 2014; 5(5): 1060-1067
Published online Dec 10, 2014. doi: 10.5306/wjco.v5.i5.1060
Clinicopathological features and treatment outcomes of brain stem gliomas in Saudi population
Yasser Bayoumi, Abdulrahman J Sabbagh, Reham Mohamed, Usama M ElShokhaiby, Ahmed Marzouk Maklad, Mutahir A Tunio, Ali Abdullah O Balbaid
Yasser Bayoumi, Consultant Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh-59046, Saudi Arabia
Yasser Bayoumi, Radiation Oncology, NCI, Cairo University, Cairo 11435, Egypt
Abdulrahman J Sabbagh, Usama M ElShokhaiby, Neurosurgery King Fahad Medical City, Riyadh-59046, Saudi Arabia
Reham Mohamed, Radiation Oncology NCI, Cairo University, Cairo 11435, Egypt
Ahmed Marzouk Maklad, Clinical Oncology, Sohag University, Sohag 11432, Egypt
Mutahir A Tunio, Ali Abdullah O Balbaid, Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh-59046, Saudi Arabia
Author contributions: Bayoumi Y and Sabbagh AJ designed the study; Mohamed R, ElShokhaiby UM, Maklad AM and Balbaid AAO collected the data; Mohamed R, Maklad AM and Tunio MA analyzed the data; Mohamed R, Maklad AM and Balbaid AAO wrote the manuscript; Bayoumi Y, Sabbagh AJ, ElShokhaiby UM and Tunio MA, edited the manuscript; Bayoumi Y, Sabbagh AJ, ElShokhaiby UM, Maklad AM and Tunio MA reviewed the manuscript.
Correspondence to: Mutahir A Tunio, FCPS (Radiation Oncology), Assistant Consultant, Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Khurais Road, Riyadh-59046, Saudi Arabia. mkhairuddin@kfmc.med.sa
Telephone: +966-12-889999 Fax: +966-12-889965
Received: February 12, 2014
Revised: April 16, 2014
Accepted: June 10, 2014
Published online: December 10, 2014
Abstract

AIM: To analyze experiences to identify treatment outcomes and prognostic factors in a Saudi population.

METHODS: Medical records of patients with brainstem gliomas treated from July 2001 to December 2012 were reviewed to identify treatment outcomes of surgery, radiation therapy and chemotherapy and associated prognostic factors in a Saudi population.

RESULTS: We analyzed 49 brain stem glioma (BSG) patients from July 2001 to December 2012; 31 of them were males (63.3%) with a median age of 12.6 years (range: 8-64 mo). Twenty-two patients (44.9%) had diffuse intrinsic pontine gliomas (DIPG) and 15 (30.6%) presented with focal/tectal BSG. Histopathology was available in 30 patients (61.2%). Median survival time for the whole cohort was 1.5 years. One and two year OS rates were 51.1% and 41.9% respectively. Two year OS rates for focal/tectal, dorsally exophytic, cervicomedullary and DIPG tumors were 60%, 33.3%, 33.3% and 13.6% respectively (P < 0.0001). Significant prognostic factors related to OS were age at diagnosis (worse for > 18 years) P = 0.01, KPS < 70 P = 0.02, duration of symptoms (< 60 d) P = 0.002, histology (better for favorable) P = 0.002, surgery (maximal resection) P = 0.002, and concurrent chemotherapy with radiation therapy in DIPG (better if given) P = 0.01.

CONCLUSION: BSG, especially the DIPG subgroup, had a dismal prognosis, needing more aggressive neurosurgical, radiation and chemotherapy techniques, while focal and tectal tumors were found to have a better prognosis.

Keywords: Brain stem glioma, Children, Adults, Saudi Arabia, Treatment outcomes

Core tip: Brain stem gliomas (BSG) are a heterogeneous group of tumors with a poor prognosis. We analyzed 49 BSG patients from July 2001 to December 2012 with a median age of 12.6 years (range: 8-64 mo). Twenty-two patients (44.9%) had diffuse intrinsic pontine gliomas (DIPG) and 15 (30.6%) presented with focal/tectal BSG. Histopathology was available in 30 patients (61.2%). Median survival time for the whole cohort was 1.5 years. One and two year OS rates were 51.1% and 41.9% respectively. Two year OS rates for focal/tectal, dorsally exophytic, cervicomedullary and DIPG tumors were 60%, 33.3%, 33.3% and 13.6% respectively (P < 0.0001). We concluded that BSG, especially the DIPG subgroup, had a dismal prognosis, needing more aggressive neurosurgical, radiation and chemotherapy techniques, while focal and tectal tumors were found to have a better prognosis.