[Controlled multimodality treatment of brain stem gliomas]

Thirty-eight children were diagnosed as having a brain stem glioma at Nagoya University. Thirty-three patients in our previous series from 1957 to 1983, were treated traditionally with radiation and at late stage with shunting operation for hydrocephalus and/or suboccipital decompression, but not with direct operation for tumors. In general, tumors constantly grew regardless histology and their mean survival time was only 7.0 months even with transient neurological remission. On the other hand, recent five patients since 1984 were treated with prospective multimodality treatment. According to neuroradiological studies by X ray and/or NMR, CT scanning, the brain stem glioma cases were classified into subgroups of intrinsic and exophytic. Then the former were treated non-surgically with adjuvant therapy of Interferon-ACNU-Radiation (IAR) and the latter were treated surgically at first by resection of the tumor followed by adjuvant therapy of IAR or interferon-CDDP. Four out of five patients responded to adjuvant therapy (complete response = 2, partial response = 2, response rate = 80%) and they are all alive after 7-28 months follow-up period. It is concluded from our results that CT scanning can diagnose the accurate location and nature of brain stem gliomas, surgical therapy benefits at least in exophytic cases, and IAR adjuvant therapy may prolong the survival time of patients.