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Abstract
Diffuse intrinsic pontine glioma (DIPG) is a primary brainstem tumor of childhood that carries a dismal prognosis, with median survival of less than 1 year. Because of the brain stem location and pattern of growth within the pons, Dr. Harvey Cushing, the father of modern neurosurgery, urged surgical abandonment. Such a dismal prognosis remained unchanged for decades, coupled with a lack of understanding of tumor biology and an unchanging therapeutic panorama. Beyond palliative external beam radiation therapy, no therapeutic approach has been widely accepted. In the last one to two decades, however, increased tissue availability, an improving understanding of biology, genetics, and epigenetics have led to the development of novel therapeutic targets. In parallel with this biological revolution, new methods intended to enhance drug delivery into the brain stem are contributing to a surge of exciting experimental therapeutic strategies.
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Affiliation(s)
- Umberto Tosi
- Department of Neurosurgery, Weill Cornell Medicine, 525 E 68th St Box 99, New York, NY, 10021, USA
| | - Mark Souweidane
- Department of Neurosurgery, Weill Cornell Medicine, 525 E 68th St Box 99, New York, NY, 10021, USA.
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Silva MA, Mirchia K, Chamyan G, Maher O, Wang S, Niazi T. Disseminated diffuse midline glioma associated with poorly differentiated orbital lesion and metastases in an 8-year-old girl: case report and literature review. Childs Nerv Syst 2022; 38:2005-10. [PMID: 35460354 DOI: 10.1007/s00381-022-05530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Disseminated diffuse midline glioma (DMG) is a devastating diagnosis. Molecular subtyping has increased our understanding of this tumor. CASE Here, we report the case of an 8-year-old girl who presented with symptoms of brainstem dysfunction and was found to have disseminated DMG with lesions in the pons, thalamus and bilateral temporal lobes. Molecular subtyping of the temporal lobe tumor tissue was consistent with H3 K27me3 loss and EZHIP overexpression, falling under the newly designated "H3 K27-altered" AQ5WHO subtype of DMG. Pathology from biopsy of the orbital lesion showed poorly differentiated rhabdoid-like disseminated tumor cells. The patient went on to develop lesions in the peritoneum, infratemporal fossa, and along the lumbosacral nerve roots. CONCLUSION This unique case illustrates the aggressive behavior of H3 K27-altered tumors and their potential to metastasize.
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Abstract
Diffuse intrinsic pontine gliomas (DIPGs) are a fairly common pediatric brain tumor, and children with these tumors have a dismal prognosis. They generally are diagnosed within the first decade of life, and due to their location within the pons, these tumors are not surgically resectable. The median survival for children with DIPGs is less than 1 year, in spite of decades of clinical trial development of unique approaches to radiation therapy and chemotherapy. Novel therapies are under investigation for these deadly tumors. As clinicians and researchers make a concerted effort to obtain tumor tissue, the molecular signals of these tumors are being investigated in an attempt to uncover targetable therapies for DIPGs. In addition, direct application of chemotherapies into the tumor (convection-enhanced delivery) is being investigated as a novel delivery system for treatment of DIPGs. Overall, DIPGs require creative thinking and a disciplined approach for development of a therapy that can improve the prognosis for these unfortunate children.
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Affiliation(s)
- Amy Lee Bredlau
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - David N Korones
- Department of Pediatrics, University of Rochester, Rochester, New York, USA; Department of Palliative Care, University of Rochester, Rochester, New York, USA
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Sewing ACP, Caretti V, Lagerweij T, Schellen P, Jansen MHA, van Vuurden DG, Idema S, Molthoff CFM, Vandertop WP, Kaspers GJL, Noske DP, Hulleman E. Convection enhanced delivery of carmustine to the murine brainstem: a feasibility study. J Neurosci Methods 2014; 238:88-94. [PMID: 25263805 DOI: 10.1016/j.jneumeth.2014.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Systemic delivery of therapeutic agents remains ineffective against diffuse intrinsic pontine glioma (DIPG), possibly due to an intact blood-brain-barrier (BBB) and to dose-limiting toxicity of systemic chemotherapeutic agents. Convection-enhanced delivery (CED) into the brainstem may provide an effective local delivery alternative for DIPG patients. NEW METHOD The aim of this study is to develop a method to perform CED into the murine brainstem and to test this method using the chemotherapeutic agent carmustine (BiCNU). To this end, a newly designed murine CED catheter was tested in vitro and in vivo. After determination of safety and distribution, mice bearing VUMC-DIPG-3 and E98FM-DIPG brainstem tumors were treated with carmustine dissolved in DW 5% or carmustine dissolved in 10% ethanol. RESULTS Our results show that CED into the murine brainstem is feasible and well tolerated by mice with and without brainstem tumors. CED of carmustine dissolved in 5% DW increased median survival of mice with VUMC-DIPG-3 and E98FM-DIPG tumors with 35% and 25% respectively. Dissolving carmustine in 10% ethanol further improved survival to 45% in mice with E98FM-DIPG tumors. COMPARISON WITH EXISTING METHODS Since genetically engineered and primary DIPG models are currently only available in mice, murine CED studies have clear advantages over CED studies in other animals. CONCLUSION CED in the murine brainstem can be performed safely, is well tolerated and can be used to study efficacy of chemotherapeutic agents orthotopically. These results set the foundation for more CED studies in murine DIPG models.
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Affiliation(s)
- A Charlotte P Sewing
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Viola Caretti
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Tonny Lagerweij
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Pepijn Schellen
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc H A Jansen
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Dannis G van Vuurden
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Sander Idema
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Carla F M Molthoff
- Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - David P Noske
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Hulleman
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands.
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