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Anatomical and Biological Imaging of Pediatric Brain Tumor
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Rob A. Dineen, Shivaram Avula, Andrew C. Peet, Giovanni Morana, Monika Warmuth-Metz
ASL has been found useful in grading children’s brain tumors. A study of 129 children found high-grade tumors to have higher CBF than low-grade tumors.46 A previous study had shown that maximum relative tumor blood flow was higher in high- than low-grade tumors and overall tumor blood flow was greater in medulloblastoma than PA.47 It had also been reported that choroid plexus carcinomas have higher rCBF than papillomas.48 An extension to this has been proposed to guide biopsy with DSC MRI identifying areas of focal anaplasia in diffuse intrinsic pontine gliomas (DIPG) characterized by higher CBV.49
Anti-EGFR nimotuzumab for DIPG in recurrent or children with high grade glioma: 10 years
Published in Cut Adeya Adella, Stem Cell Oncology, 2018
U. Bone, R. Cabanas, G. Saurez-Martinez, T. Crombet Ramos, P. Lorenzo-Luaces, M. Massimino, U. Bartels, E. Bouffet, F. Bach, D. Reuter, R.A. Ilyas, R. Ellerson, N. Iznaga-Escobar
Brain tumors are a heterogeneous group of neoplasms, each with its biology, treatment, and prognosis. New therapies are needed, especially for the astrocytic gliomas. In particular brain stem gliomas (BSG) remain the most problematic childhood brain tumor to treat. BSG comprises 10-15% of all pediatric CNS tumors and is uncommon in the adult population. Peak incidence is between 5-9 years of age but may occur anytime in the childhood. These lesions tend to be located in the pons and are termed diffuse intrinsic pontine gliomas (DIPG), which constitute approximately 75-80% of all childhood brain stem gliomas. This DIPG will respond transiently to radiotherapy but have not yet been shown to benefit from the addition of chemotherapy (Paker et al., 1990). After radiotherapy, progressive disease and death will occur in approximately 90% of the patients within 8-10 months of diagnosis.
Chordoid Glioma, Angiocentric Glioma, and Diffuse Midline Glioma
Published in Dongyou Liu, Tumors and Cancers, 2017
Diffuse midline glioma is a common type of diffuse intrinsic pontine glioma (DIPG) that arises within the pons (called pontine glioma or diffuse intrinsic brainstem glioma). Pontine glioma is usually high grade and locally infiltrative, displaying histological similarity to anaplastic astrocytoma (WHO Grade III) or glioblastoma (WHO Grade IV) and carrying a specific point mutation (K27M) in histone H3 (called diffuse midline glioma H3 K27M–mutant, WHO Grade IV). In contrast, some 20% of brainstem tumors affect the cervicomedullary junction and tectum (known as nonpontine glioma). Nonpontine glioma is usually a low-grade, discrete, and well-circumscribed astrocytoma (e.g., pilocytic astrocytoma WHO Grade I), although about 10%–20% of nonpontine gliomas may be high grade and behave similarly to DIPGs [1,2].
Re-irradiation for recurrent/progressive pediatric brain tumors: from radiobiology to clinical outcomes
Published in Expert Review of Anticancer Therapy, 2023
Mohamed S. Zaghloul, Alistair Hunter, Ayatullah G. Mostafa, Jeannette Parkes
Meaningful palliation and prolonged survival for a few months were achieved through re-irradiating patients with progressive diffuse intrinsic pontine glioma (DIPG) upon progression after initial focal radiotherapy with or without chemotherapy [2,48,49]. The interval between initial radiation and progression (>6 months) and toxicity with the first irradiation were the prognostic factors determining the length of the second PFS [50,51]. The re-irradiation dose ranged between 18 and 36 Gy, with no apparent statistical differences between dose levels. Many centers use re-reirradiation without reporting much toxicity [52]. In a retrospective study comparing 82 cases of progressive DIPG who received re-irradiation 20–26 Gy to 89 comparable patients of progressive DIPG who received the best supportive care, the median OS was 6.9 and 2.4 months, respectively (p = 0.001). Re-irradiation offered 4.5 months’ prolongation of OS. The authors found that the only significant prognostic factor was a clinical improvement after re-irradiation (p = 0.001). On the other hand, the MR improvement had only a trend of statistical significance (p = 0.07) [53]. On the other hand, SIOP-E showed 31 children with progressive DIPG with a re-irradiation dose of ≥20 Gy provides a neurological improvement of symptoms in more than 60% of patients. However, there was no improvement in survival between responding and non-responding patients [54].
Flying rats and microbeam paths crossing: the beauty of international interdisciplinary science
Published in International Journal of Radiation Biology, 2022
In 2004, we were preparing for our first cancer therapy study to be conducted at the biomedical beamline ID 17 of the ESRF, using a small animal model of malignant brain tumor to help validating a new and promising radiotherapy concept called microbeam radiotherapy (MRT). What we did not know yet was that soon, our research group was to become one of the driving forces in an international interdisciplinary research community. A community where learning each other’s professional language is as important as to be precise in one’s expressions and requests. Because the terminology and the expectations are fundamentally different between clinicians and mathematicians, between biologists, physicists and engineers. And yet, all of them need to work together in order to make the dream of the MRT pioneers come true: to improve the quality of life for patients with malignant brain tumors. To successfully treat patients afflicted with tumors for which currently no satisfactory therapeutic concepts exist, like children with diffuse intrinsic pontine glioma (Grotzer et al. 2015). These tumors typically show a diffuse invasion and enlargement of the pons, sometimes also an infiltration of the midbrain and the cerebellar peduncles, causing debilitating neurological symptoms. The diffuse, invasive growth pattern and localization renders them unsuitable for neurosurgical removal. Conventional radiotherapy can temporarily control the tumor and even revert the neurologic symptoms associated with it, but the duration of this respite is measured in weeks or months rather than in years.
Targets for MAbs: innovative approaches for their discovery & validation, LabEx MAbImprove 6th antibody industrial symposium, June 25-26, 2018, Montpellier, France
Published in mAbs, 2019
Pierre Martineau, Hervé Watier, Andre Pèlegrin, Andrei Turtoi
Other appealing clinical examples were provided to demonstrate the value of [89Zr]-immuno-PET. One of the most challenging brain tumors in children is diffuse intrinsic pontine glioma (DIPG), a lethal childhood malignancy of the brainstem comprising 10% of all pediatric central nervous system tumors. DIPG tumors are resistant to all kinds of systemic therapies, including targeted agents, and hardly any patient survives beyond 2 years from diagnosis. One hypothesis for therapy failure is that drugs actually do not reach the tumors. Indeed, immuno-PET studies with [89Zr]-bevacizumab revealed that this antibody did not enter most of the tumors, and hence was ineffective. Alternative drug delivery options should be explored for these children. Immune checkpoint inhibitors are another example where we do not know what the ideal distribution would be, which patients will benefit and how efficacy can be improved. First-in-human imaging studies with a [18F]-labeled PD-L1 ligand and [89Zr]-labeled nivolumab (anti-PD1 to block interaction with PD-L1) demonstrated strong tumor distributions in responder patients. At the end of the lecture, Prof. Van Dongen stressed that immuno-PET should be used to determine the right patient, right disease, right drug, right dose, right moment and right outcome.