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A Protocol for Rapid Post-mortem Cell Culture of Diffuse Intrinsic Pontine Glioma DIPG
Published on: March 7, 2017
A multimodal imaging-based classification for pediatric diffuse intrinsic pontine gliomas
Changcun Pan1, Mingxin Zhang1, Xiong Xiao1
1Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China.
Insights
A new imaging classification for pediatric diffuse intrinsic pontine glioma (DIPG) identifies four types. This classification aids in selecting optimal treatments, potentially improving outcomes with cytoreductive surgery plus radiotherapy (CRS+RT).
Area of Science:
- Pediatric neuro-oncology
- Radiology
- Medical imaging analysis
Background:
- Pediatric diffuse intrinsic pontine glioma (DIPG) presents with significant radiological heterogeneity.
- Current treatment strategies lack tailored approaches based on specific DIPG subtypes.
- A need exists for a classification system to guide personalized treatment in DIPG.
Purpose of the Study:
- To establish a multimodal imaging-based radiological classification for pediatric DIPG.
- To evaluate the efficacy of different treatment strategies within this new classification framework.
- To identify optimal treatment pathways for specific DIPG radiological subtypes.
Main Methods:
- Retrospective analysis of 103 pediatric DIPG cases.
- Utilized conventional MRI, DTI/DTT, and PET for radiological characterization.
- Applied Kaplan-Meier analysis to compare treatment outcomes across DIPG subgroups.
Main Results:
- Four distinct radiological DIPG types were identified: Type A (homocentric), Type B (ventral), Type C (eccentric), and Type D (dorsal).
- Treatment modalities included observation, cytoreductive surgery (CRS) plus radiotherapy (RT), RT alone, and CRS alone.
- CRS+RT was predominantly used in Type C, B1, and D, showing a trend towards survival advantage over RT alone, though not statistically significant.
Conclusions:
- A novel multimodality imaging-based classification for pediatric DIPG has been proposed.
- This classification system is valuable for selecting optimal treatments, particularly identifying candidates for CRS plus RT.
- The classification facilitates image-guided integrated treatment strategies for pediatric DIPG.
Object:
Pediatric diffuse intrinsic pontine glioma (DIPG) is a radiologically heterogeneous disease entity, here we aim to establish a multimodal imaging-based radiological classification and evaluate the outcome of different treatment strategies under this classification frame.
Methods:
This retrospective study included 103 children diagnosed with DIPGs between January 2015 and August 2018 in Beijing Tiantan Hospital (Beijing, China). Multimodal radiological characteristics, including conventional magnetic resonance imaging (MRI), diffuse tensor imaging/diffuse tensor tractography (DTI/DTT), and positron emission tomography (PET) were reviewed to construct the classification. The outcome of different treatment strategies was compared in each DIPG subgroup using Kaplan-Meier method (log-rank test) to determine the optimal treatment for specific DIPGs.
Results:
Four radiological DIPG types were identified: Type A ("homocentric", n=13), Type B ("ventral", n=41), Type C ("eccentric", n=37), and Type D ("dorsal", n=12). Their treatment modalities were grouped as observation (43.7%), cytoreductive surgery (CRS) plus radiotherapy (RT) (24.3%), RT alone (11.7%), and CRS alone (20.4%). CRS+RT mainly fell into type C (29.7%), followed by type B1 (21.9%) and type D (50%). Overall, CRS+RT exhibited a potential survival advantage compared to RT alone, which was more pronounced in specific type, but this did not reach statistical significance, due to limited sample size and unbalanced distribution.
Conclusion:
We proposed a multimodality imaging-based radiological classification for pediatric DIPG, which was useful for selecting optimal treatment strategies, especially for identifying candidates who may benefit from CRS plus RT. This classification opened a window into image-guided integrated treatment for pediatric DIPG.
