Favorable outcome with conservative treatment for children with low grade brainstem tumors

Background Pediatric brainstem tumors (BST) comprise a heterogeneous group of entities. Data regarding treatment options and outcome of BST, specifically brainstem low grade tumors (BSLGT) are limited. In order to better define risk groups and evaluate treatment options for pediatric BST, we performed a comprehensive analysis of all BST patients treated in our hospital during the MRI era. Procedures. We retrospectively analyzed clinical, imaging, and pathology data at presentation, treatment, and outcome of all BST patients followed at the Hospital for Sick Children in Toronto over the last 25 years. Results. Of 1,801 children with brain tumors, 223 (12%) had a brainstem primary location. Tumors without pontine involvement were BSLGT in 98.3%, whereas 75% of tumors involving the pons were high grade (P = 0.0001). Patients with BSLGT had 5-year progression-free survival (PFS) and overall survival (OS) of 57 +/- 3% and 89 +/- 5%, respectively. Upfront observation of tumor residual conferred no survival disadvantage with 5-year PFS and OS of 57 +/- 5% and 93 +/- 3%, respectively. In the group of patients requiring further treatment, 5-year PFS and OS were comparable between chemotherapy and radiotherapy with 53 +/- 12% and 93 +/- 4% and 66 +/- 11% and 83 +/- 6%, respectively (P = 0.26 and 0.3, respectively). Conclusion. BST without pontine involvement are almost invariably BSLGT. Children with BSLGT have an excellent outcome even with careful initial observation. No clear benefit was observed for radiotherapy over chemotherapy when adjuvant treatment was needed. A conservative approach may be warranted for children with non-pontine brainstem lesions. Pediatr Blood Cancer 2012; 58: 556-560. (C) 2011 Wiley Periodicals, Inc.