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National trends in the treatment of adult diffuse midline gliomas: a rare clinical scenario.

Jay Desai1, Sujay Rajkumar1, Matthew J Shepard2

  • 1Drexel University College of Medicine, Philadelphia, USA.

Journal of Neuro-Oncology
|April 17, 2024
PubMed
Summary

Despite ineffective treatments, chemotherapy is common for diffuse midline gliomas (DMG). Comorbidity index and race significantly impact survival in these aggressive brain tumors.

Keywords:
Adult diffuse midline gliomasChemotherapyNational cancer databaseRadiation therapy

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Area of Science:

  • Neuro-oncology
  • Cancer genomics
  • Clinical research

Background:

  • Diffuse midline gliomas (DMG) are aggressive World Health Organization grade 4 brain tumors.
  • Characterized by histone H3 K27M mutation, DMG has a poor prognosis with mean survival of 9-19 months.
  • No standard treatment exists, with radiation offering only marginal survival benefits.

Purpose of the Study:

  • To analyze current treatment trends for diffuse midline gliomas (DMG).
  • To identify predictors of overall survival in adult patients with DMG.
  • To evaluate the impact of various factors on DMG patient outcomes.

Main Methods:

  • Retrospective analysis of the National Cancer Database (2016-2020).
  • Included adult patients treated with primary brain radiation, with or without chemotherapy.
  • Univariable and multivariable Cox regression models were employed to identify survival predictors.

Main Results:

  • 131 patients met inclusion criteria; 86% received concurrent chemotherapy with radiation.
  • Charlson-Deyo comorbidity index and race were significant predictors of survival.
  • Higher comorbidity scores and non-White/Black race were associated with increased mortality risk.

Conclusions:

  • Chemotherapy is frequently administered to DMG patients despite questionable efficacy.
  • Charlson-Deyo comorbidity index and patient race are critical prognostic factors for DMG survival.
  • Further research is needed to establish effective treatment standards for DMG.