Tumor dissemination through surgical tracts in diffuse intrinsic pontine glioma
Por:
Lobon-Iglesias MJ, Salvador-Marcos N, Puerta Roldan P, Candela-Cantó SA, Ramos-Albiac M, Gómez-Chiari M, Puget S, Bolle S, Goumnerova L, Kieran MW, Cruz-Martínez O, Grill J and Morales-La Madrid A
Publicada:
1 dic 2018
Ahead of Print:
7 sep 2018
Resumen:
OBJECTIVE Diffuse intrinsic pontine glioma (DIPG) is a highly aggressive and lethal brainstem tumor in children. In the 1980s, routine biopsy at presentation was abandoned since it was claimed "unnecessary" for diagnosis. In the last decade, however, several groups have reincorporated this procedure as standard of care or in the context of clinical trials. Expert neurosurgical teams report no mortality and acceptable morbidity, and no relevant complications have been previously described. The aim of this study was to review needle tract dissemination as a potential complication in DIPG.
METHODS The authors retrospectively analyzed the incidence of dissemination through surgical tracts in DIPG patients who underwent biopsy procedures at diagnosis in 3 dedicated centers. Clinical records and images as well as radiation dosimetry from diagnosis to relapse were reviewed.
RESULTS Four patients (2 boys and 2 girls, age range 6-12 years) had surgical tract dissemination: in 3 cases in the needle tract and in 1 case in the Ommaya catheter tract. The median time from biopsy to identification of dissemination was 5 months (range 4-6 months). The median overall survival was 11 months (range 7-12 months). Disseminated lesions were in the marginal radiotherapy field (n = 2), out of the field (n = 1), and in the radiotherapy field (n = 1).
CONCLUSIONS Although surgical tract dissemination in DIPG is a rare complication (associated with 2.4% of procedures in this study), it should be mentioned to patients and family when procedures involving a surgical tract are proposed. The inclusion of the needle tract in the radiotherapy field may have only limited benefit. Future studies are warranted to explore the benefit of larger radiotherapy fields in patients with DIPG.
Filiaciones:
Lobon-Iglesias MJ:
Department of Pediatric and Adolescent Oncology and
Team Target Identification and Innovative Anticancer Therapies in Pediatric Cancers, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif
Salvador-Marcos N:
Department of Pediatric Hematology and Oncology
Pediatric Neuro-Oncology, Department of Pediatric Hematology and Oncology
Puerta Roldan P:
Department of Pediatric Neurosurgery, and
Candela-Cantó SA:
Department of Pediatric Neurosurgery, and
Ramos-Albiac M:
Department of Radiation Oncology, Hospital Vall d'Hebron, Barcelona, Spain
Gómez-Chiari M:
Department of Radiology, Hospital Sant Joan de Déu
Puget S:
Department of Pediatric Neurosurgery, Necker Sick Children's Hospital and University Paris-Descartes, Paris, France
Bolle S:
Department of Radiation Therapy, Gustave Roussy and University Paris-Saclay, Villejuif
Goumnerova L:
Department of Neurosurgery, Boston Children's Hospital
and
Kieran MW:
The Pediatric Brain Tumor Program, Department of Pediatric Oncology, Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
Cruz-Martínez O:
Department of Pediatric Hematology and Oncology
Pediatric Neuro-Oncology, Department of Pediatric Hematology and Oncology
Grill J:
Department of Pediatric and Adolescent Oncology and
Team Target Identification and Innovative Anticancer Therapies in Pediatric Cancers, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif
Morales-La Madrid A:
Department of Pediatric Hematology and Oncology
Pediatric Neuro-Oncology, Department of Pediatric Hematology and Oncology
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