Demographic and prognostic factors of optic nerve astrocytoma: a retrospective study of surveillance, epidemiology, and end results (SEER)

Gliomas of the Optic Nerve: A SEER-Based Epidemiologic Study

BACKGROUND

To determine whether patients with biopsy-confirmed optic nerve glioma differ in clinical features and outcomes from those diagnosed by neuroradiologic imaging alone.

METHODS

Retrospective comparative analysis. Pilocytic astrocytomas (PAs) and gliomas of the optic nerve were identified through ICD-O codes in the Surveillance, Epidemiology, and End Results (SEER) cancer registry from 1975 through 2017. Demographics, clinical features, and outcomes were compared according to the method of diagnosis (biopsy-confirmed and radiologic only) and by age (birth through 19 years and 20 years of age and older). Differences in proportions were tested with the chi-square test. Associations with tumor-related death were evaluated with logistic regression. Statistical significance: α < 0.01.

RESULTS

Over 42 years, 313 PAs and 720 gliomas of the optic nerve were identified. The young age distributions were similar between the 2 groups. PAs were biopsied more often than gliomas (54% vs 13.2% [ P < 0.001]). Tumor-attributable death occurred more often among PAs and gliomas that were biopsied than those that were not (7.1% vs 0.7% [ P < 0.01]; 7.4% vs 1.1% [ P < 0.01], respectively). Roughly 15% of both PAs and gliomas were diagnosed in persons 20 years and older.

CONCLUSIONS

Biopsy-confirmed cases of PA and glioma of the optic nerve were associated with more therapeutic interventions and worse outcomes compared with patients who were diagnosed radiologically. Clinical variables relevant to clinical decision-making not captured by SEER likely explain the inability to meaningfully interpret outcome from the registry database. Cancer registries should avoid coding specific histopathologic diagnoses when tissue is not obtained.

Diencephalic Syndrome Due to Optic Pathway Gliomas in Pediatric Patients: An Italian Multicenter Study

Diencephalic syndrome (DS) is a rare pediatric condition associated with optic pathway gliomas (OPGs). Since they are slow-growing tumors, their diagnosis might be delayed, with consequences on long-term outcomes. We present a multicenter case series of nine children with DS associated with OPG, with the aim of providing relevant details about mortality and long-term sequelae. We retrospectively identified nine children (6 M) with DS (median age 14 months, range 3-26 months). Four patients had NF1-related OPGs. Children with NF1 were significantly older than sporadic cases (median (range) age in months: 21.2 (14-26) versus 10 (3-17); p = 0.015). Seven tumors were histologically confirmed as low-grade astrocytomas. All patients received upfront chemotherapy and nutritional support. Although no patient died, all of them experienced tumor progression within 5.67 years since diagnosis and were treated with several lines of chemotherapy and/or surgery. Long-term sequelae included visual, pituitary and neurological dysfunction. Despite an excellent overall survival, PFS rates are poor in OPGs with DS. These patients invariably present visual, neurological or endocrine sequelae. Therefore, functional outcomes and quality-of-life measures should be considered in prospective trials involving patients with OPGs, aiming to identify "high-risk" patients and to better individualize treatment.

Optical Coherence Tomography Identifies Visual Pathway Involvement Earlier than Visual Function Tests in Children with MRI-Verified Optic Pathway Gliomas

Simple Summary

Retrograde degeneration of the eye’s retinal ganglion cells, causing visual loss and even blindness, is a feared consequence of optic pathway gliomas. Optical coherence tomography (OCT) is a patient-friendly, high-resolution imaging technique enabling objective measurements of the integrity of the retinal ganglion cell layer. Children with optic pathway glioma unable to complete formal visual field testing and/or reliable visual acuity testing, may undergo OCT, providing objective information about visual loss and potential clinical progression. By combining visual functional measurements with OCT findings, the clinical examination will be safer and more reliable. By improving the clinical follow-up of the tumor, the treatment choices can be optimized thereby preventing further visual loss and, in the worst case, blindness.

Abstract

This study investigates whether optical coherence tomography (OCT) could add useful information in the examination of children with optic pathway glioma (OPG) at high risk of developing vision loss. For this purpose, the relationship between ganglion cell-inner plexiform layer (GC-IPL) thickness and visual function, evaluated with tests of visual acuity (VA) and visual field (VF), as well as tumor site according to magnetic resonance imaging (MRI), were examined in a geographically defined group of children with OPG. Methods: Children aged <18 years with OPG underwent ophthalmic examination including VA, VF (Zeiss HFA perimetry) and OCT imaging (Zeiss Cirrus HD-OCT). Results: Out of 51 patients included, 45 provided 77 eyes with MRI-verified OPG, and 19 patients provided 25 eyes without OPG. Significant correlations were found between GC-IPL, VF and VA (p < 0.001). The GC-IPL pattern loss corresponded in 95% to VF defects and in 92% to MRI findings. Conclusions: Our study indicates that GC-IPL measures could serve as an early marker of vision-threatening changes related to OPG and as a valuable link between MRI and visual function tests. Thinning of GC-IPL and differences in topography between eyes are strong indicators of and predictive of vision loss related to OPG.

GROSS TOTAL RESECTION IN A RARE CASE OF OPTIC NERVE ASTROCYTOMA: A CASE REPORT

The authors present a 3-year-old female with increasing proptosis and absent vision in the right eye. Chemotherapy had done for 3months. But her ailments lingered. The right eye exhibited severe proptosis and poor vision, whereas the left eye was normal with 20/20 vision. Preoperative MRI revealed a dumbbell-shaped tumor in the intra-orbital and intra-cranial section of the right optic nerve. A lateral supra-orbital approach was used to dissect the dumbbell-shaped tumor and the right optic nerve. No remnant of the tumor was discovered during a follow-up examination. The case study demonstrates how to identify and treat ONA surgically. However, we need further research on optic nerve PA to gain a better understanding of their behavior. While gross total resection (GTR) is usually curative, tumors in deep locations may be unresectable and require alternative therapeutic procedures. Additionally, the case study emphasizes the importance of additional research on early detection and prevention.