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J Neurol Surg A Cent Eur Neurosurg 2012; 73(03): 187-191
DOI: 10.1055/s-0032-1313633
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Progressive Brain Stem Glioma With Bevacizumab: Radiological, Metabolic and Histopathological Aspects[*]

T. Reithmeier
1   University Hospital Freiburg, Department of Stereotactic and Functional Neurosurgery, Freiburg, Germany
,
C. Rottenburger
2   University Hospital Freiburg, Department of Nuclear Medicine, Freiburg, Germany
,
S. Doostkam
3   University of Freiburg, Department of Neuropathology, Freiburg, Germany
,
M. O. Pinsker
3   University of Freiburg, Department of Neuropathology, Freiburg, Germany
,
M. Trippel
1   University Hospital Freiburg, Department of Stereotactic and Functional Neurosurgery, Freiburg, Germany
,
B. Bosche
4   University Hospital Cologne, Department of Neurosurgery, Cologne, Germany
,
W. Weber
2   University Hospital Freiburg, Department of Nuclear Medicine, Freiburg, Germany
,
M. Prinz
3   University of Freiburg, Department of Neuropathology, Freiburg, Germany
,
G. Nikkhah
1   University Hospital Freiburg, Department of Stereotactic and Functional Neurosurgery, Freiburg, Germany
› Author Affiliations
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Publication History

Publication Date:
24 May 2012 (online)

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Treatment of Progressive Brain Stem Glioma With Bevacizumab: Radiological, Metabolic and Histopathological AspectsCent Eur Neurosurg 2011; 72(S 01): e22-e22
DOI: 10.1055/s-0031-1275692

Introduction

Brain stem gliomas in adults are rare (about 2% of all brain tumors) and little is known about their biological behavior, clinical course, and optimal treatment strategy.[5] Additionally, reports about brain stem gliomas in adults are often based on radiological features without histopathological confirmation of the diagnosis. In contrast to pediatric brain stem gliomas, which have a typical radiological appearance, there is a wide range of differential diagnoses for lesions within the brain stem in adults: intrinsic brain tumors, metastasis, abscess, encephalitis, lymphoma, demyelinating disorders, and infarction. Therefore the histological confirmation of a brain stem glioma is a precondition for any treatment decision, including radiation- or chemotherapy and administration of second-line chemotherapeutic agents like bevacizumab. In this paper, we report the radiological, metabolic, and clinical effects of treatment with bevacizumab for a histologically proven brain stem glioma (astrocytoma WHO II), which was progressive after radiation therapy and chemotherapy with temozolomide. The relevance of the molecular biological features like the MGMT status and the VEGF expression for treatment decisions are also discussed.

* This article was originally published online in Central European Neurosurgery on November 2, 2011 (DOI:10.1055/s-0031-1275692)


 

  • References

  • 1 Brandsma D, Stalpers L, Taal W , et al. Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol 2008; 9: 453-461
    CrossrefPubMedSearch in Google Scholar
  • 2 Chahal M, Xu Y, Lesniak D , et al. MGMT modulates glioblastoma angiogenesis and response to the tyrosine kinase inhibitor sunitinib. Neuro Oncol 2010; 12: 822-833
    CrossrefPubMedSearch in Google Scholar
  • 3 Chen W, Delaloye S, Silverman DH , et al. Predicting treatment response of malignant gliomas to bevacizumab and irinotecan by imaging proliferation with [18F] fluorothymidine positron emission tomography: a pilot study. J Clin Oncol 2007; 25: 4714-4721
    CrossrefPubMedSearch in Google Scholar
  • 4 Hegi ME, Diserens AC, Gorlia T , et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005; 352: 997-1003
    CrossrefPubMedSearch in Google Scholar
  • 5 Laigle-Donadey F, Doz F, Delattre JY. Brain stem gliomas in children and adults. Curr Opin Oncol 2008; 20: 662-667 J Neurooncol 2008; 87: 355–361
    CrossrefPubMedSearch in Google Scholar
  • 6 Rachinger W, Goetz C, Pöpperl G , et al. Positron emission tomography with O-(2-[18F]fluoroethyl)-l-tyrosine versus magnetic resonance imaging in the diagnosis of recurrent gliomas. Neurosurgery 2005; 57: 505-511
    CrossrefPubMedSearch in Google Scholar
  • 7 Rachinger W, Grau S, Holtmannspötter M , et al. Serial stereotactic biopsy of brain stem lesions in adults improves diagnostic accuracy compared with MRI only. J Neurol Neurosurg Psychiatry 2009; 80: 1134-1139
    CrossrefPubMedSearch in Google Scholar
  • 8 Tilgner J, Herr M, Ostertag C , et al. Validation of intraoperative diagnosis using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis–influence of clinical factors. Neurosurgery 2005; 56: 256-265
    CrossrefPubMedSearch in Google Scholar
  • 9 Torcuator R, Zungia R, Loutfi R , et al. Bevacizumab and irinotecan treatment for progressive diffuse brain stem glioma: case report. J Neurooncol 2009; 93: 409-412
    CrossrefPubMedSearch in Google Scholar
  • 10 Tsuyuguchi N, Takami T, Sunada I , et al. Methionine positron emission tomography for differentiation of recurrent brain tumor and radiation necrosis after stereotactic radiosurgery – in malignant glioma. Ann Nucl Med 2004; 18: 291-296
    CrossrefPubMedSearch in Google Scholar