Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma

Alberto Broniscer, Fred H. Laningham, Mehmet Kocak, Matthew J. Krasin, Maryam Fouladi, Thomas E. Merchant, Larry E. Kun, James M. Boyett, Amar Gajjar

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

BACKGROUND. Children with diffuse brainstem glioma (BSG) commonly undergo novel therapies because their outcome is poor with radiation therapy (RT). Although recent clinical trials using new biologic agents documented intratumoral hemorrhage (IH) among several children with BSG, to the authors' knowledge little is known regarding this phenomenon. In the current study, the authors assessed the characteristics and estimated the cumulative incidence of IH among children with BSG. METHODS. All available brain imaging studies and medical records of 48 consecutive patients with newly diagnosed BSG treated at the study institution over a 10-year interval (1992-2002) were reviewed. Treatment was comprised of RT and various regimens of conventional chemotherapy; none of these patients received biologic agents. At the time of last follow-up, all patients had died of tumor progression. RESULTS. The authors reviewed 319 imaging studies (251 magnetic resonance imaging scans and 68 computed tomography scans). IH was present in 6.25% of patients at the time of diagnosis. The 6-month and 12-month cumulative incidence estimates of IH regardless of the associated symptoms were 15.5% ± 5.5% and 24.4% ± 6.5%, respectively. The same estimates for symptomatic cases were 8.9% ± 4% and 17.8% ± 6%, respectively. All cases of IH at the time of diagnosis and 78% of symptomatic cases that developed after diagnosis were located in necrotic areas. CONCLUSIONS. Although IH is uncommon at the time of diagnosis, symptomatic IH may occur among nearly 20% of children after the diagnosis of BSG. The uniform occurrence of IH among patients treated with various chemotherapeutic regimens and its association with necrotic areas suggests that tumor biology plays a significant role in this event.

Original languageEnglish (US)
Pages (from-to)1364-1371
Number of pages8
JournalCancer
Volume106
Issue number6
DOIs
StatePublished - Mar 15 2006

Fingerprint

Glioma
Brain Stem
Hemorrhage
Biological Factors
Radiotherapy
Incidence
Neuroimaging
Medical Records
Neoplasms
Tomography
Magnetic Resonance Imaging
Clinical Trials
Drug Therapy
Therapeutics

Keywords

  • Brainstem
  • Chemotherapy
  • Children
  • Glioma
  • Hemorrhage
  • Intratumoral
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Broniscer, A., Laningham, F. H., Kocak, M., Krasin, M. J., Fouladi, M., Merchant, T. E., ... Gajjar, A. (2006). Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma. Cancer, 106(6), 1364-1371. https://doi.org/10.1002/cncr.21749

Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma. / Broniscer, Alberto; Laningham, Fred H.; Kocak, Mehmet; Krasin, Matthew J.; Fouladi, Maryam; Merchant, Thomas E.; Kun, Larry E.; Boyett, James M.; Gajjar, Amar.

In: Cancer, Vol. 106, No. 6, 15.03.2006, p. 1364-1371.

Research output: Contribution to journalReview article

Broniscer, A, Laningham, FH, Kocak, M, Krasin, MJ, Fouladi, M, Merchant, TE, Kun, LE, Boyett, JM & Gajjar, A 2006, 'Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma', Cancer, vol. 106, no. 6, pp. 1364-1371. https://doi.org/10.1002/cncr.21749
Broniscer A, Laningham FH, Kocak M, Krasin MJ, Fouladi M, Merchant TE et al. Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma. Cancer. 2006 Mar 15;106(6):1364-1371. https://doi.org/10.1002/cncr.21749
Broniscer, Alberto ; Laningham, Fred H. ; Kocak, Mehmet ; Krasin, Matthew J. ; Fouladi, Maryam ; Merchant, Thomas E. ; Kun, Larry E. ; Boyett, James M. ; Gajjar, Amar. / Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma. In: Cancer. 2006 ; Vol. 106, No. 6. pp. 1364-1371.
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title = "Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma",
abstract = "BACKGROUND. Children with diffuse brainstem glioma (BSG) commonly undergo novel therapies because their outcome is poor with radiation therapy (RT). Although recent clinical trials using new biologic agents documented intratumoral hemorrhage (IH) among several children with BSG, to the authors' knowledge little is known regarding this phenomenon. In the current study, the authors assessed the characteristics and estimated the cumulative incidence of IH among children with BSG. METHODS. All available brain imaging studies and medical records of 48 consecutive patients with newly diagnosed BSG treated at the study institution over a 10-year interval (1992-2002) were reviewed. Treatment was comprised of RT and various regimens of conventional chemotherapy; none of these patients received biologic agents. At the time of last follow-up, all patients had died of tumor progression. RESULTS. The authors reviewed 319 imaging studies (251 magnetic resonance imaging scans and 68 computed tomography scans). IH was present in 6.25{\%} of patients at the time of diagnosis. The 6-month and 12-month cumulative incidence estimates of IH regardless of the associated symptoms were 15.5{\%} ± 5.5{\%} and 24.4{\%} ± 6.5{\%}, respectively. The same estimates for symptomatic cases were 8.9{\%} ± 4{\%} and 17.8{\%} ± 6{\%}, respectively. All cases of IH at the time of diagnosis and 78{\%} of symptomatic cases that developed after diagnosis were located in necrotic areas. CONCLUSIONS. Although IH is uncommon at the time of diagnosis, symptomatic IH may occur among nearly 20{\%} of children after the diagnosis of BSG. The uniform occurrence of IH among patients treated with various chemotherapeutic regimens and its association with necrotic areas suggests that tumor biology plays a significant role in this event.",
keywords = "Brainstem, Chemotherapy, Children, Glioma, Hemorrhage, Intratumoral, Radiation therapy",
author = "Alberto Broniscer and Laningham, {Fred H.} and Mehmet Kocak and Krasin, {Matthew J.} and Maryam Fouladi and Merchant, {Thomas E.} and Kun, {Larry E.} and Boyett, {James M.} and Amar Gajjar",
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T1 - Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma

AU - Broniscer, Alberto

AU - Laningham, Fred H.

AU - Kocak, Mehmet

AU - Krasin, Matthew J.

AU - Fouladi, Maryam

AU - Merchant, Thomas E.

AU - Kun, Larry E.

AU - Boyett, James M.

AU - Gajjar, Amar

PY - 2006/3/15

Y1 - 2006/3/15

N2 - BACKGROUND. Children with diffuse brainstem glioma (BSG) commonly undergo novel therapies because their outcome is poor with radiation therapy (RT). Although recent clinical trials using new biologic agents documented intratumoral hemorrhage (IH) among several children with BSG, to the authors' knowledge little is known regarding this phenomenon. In the current study, the authors assessed the characteristics and estimated the cumulative incidence of IH among children with BSG. METHODS. All available brain imaging studies and medical records of 48 consecutive patients with newly diagnosed BSG treated at the study institution over a 10-year interval (1992-2002) were reviewed. Treatment was comprised of RT and various regimens of conventional chemotherapy; none of these patients received biologic agents. At the time of last follow-up, all patients had died of tumor progression. RESULTS. The authors reviewed 319 imaging studies (251 magnetic resonance imaging scans and 68 computed tomography scans). IH was present in 6.25% of patients at the time of diagnosis. The 6-month and 12-month cumulative incidence estimates of IH regardless of the associated symptoms were 15.5% ± 5.5% and 24.4% ± 6.5%, respectively. The same estimates for symptomatic cases were 8.9% ± 4% and 17.8% ± 6%, respectively. All cases of IH at the time of diagnosis and 78% of symptomatic cases that developed after diagnosis were located in necrotic areas. CONCLUSIONS. Although IH is uncommon at the time of diagnosis, symptomatic IH may occur among nearly 20% of children after the diagnosis of BSG. The uniform occurrence of IH among patients treated with various chemotherapeutic regimens and its association with necrotic areas suggests that tumor biology plays a significant role in this event.

AB - BACKGROUND. Children with diffuse brainstem glioma (BSG) commonly undergo novel therapies because their outcome is poor with radiation therapy (RT). Although recent clinical trials using new biologic agents documented intratumoral hemorrhage (IH) among several children with BSG, to the authors' knowledge little is known regarding this phenomenon. In the current study, the authors assessed the characteristics and estimated the cumulative incidence of IH among children with BSG. METHODS. All available brain imaging studies and medical records of 48 consecutive patients with newly diagnosed BSG treated at the study institution over a 10-year interval (1992-2002) were reviewed. Treatment was comprised of RT and various regimens of conventional chemotherapy; none of these patients received biologic agents. At the time of last follow-up, all patients had died of tumor progression. RESULTS. The authors reviewed 319 imaging studies (251 magnetic resonance imaging scans and 68 computed tomography scans). IH was present in 6.25% of patients at the time of diagnosis. The 6-month and 12-month cumulative incidence estimates of IH regardless of the associated symptoms were 15.5% ± 5.5% and 24.4% ± 6.5%, respectively. The same estimates for symptomatic cases were 8.9% ± 4% and 17.8% ± 6%, respectively. All cases of IH at the time of diagnosis and 78% of symptomatic cases that developed after diagnosis were located in necrotic areas. CONCLUSIONS. Although IH is uncommon at the time of diagnosis, symptomatic IH may occur among nearly 20% of children after the diagnosis of BSG. The uniform occurrence of IH among patients treated with various chemotherapeutic regimens and its association with necrotic areas suggests that tumor biology plays a significant role in this event.

KW - Brainstem

KW - Chemotherapy

KW - Children

KW - Glioma

KW - Hemorrhage

KW - Intratumoral

KW - Radiation therapy

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DO - 10.1002/cncr.21749

M3 - Review article

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