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Modrzejewska M, Olejnik-Wojciechowska J, Roszyk A, Szychot E, Konczak TD, Szemitko M, Peregud-Pogorzelski JW. Optic Pathway Gliomas in Pediatric Population-Current Approach in Diagnosis and Management: Literature Review. J Clin Med 2023; 12:6709. [PMID: 37959175 PMCID: PMC10649937 DOI: 10.3390/jcm12216709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
In this paper, the authors present a clinical picture of the diagnosis and current treatment regimens of optic pathway glioma in the pediatric population, with an emphasis on the role of an ophthalmic diagnosis in the differentiation and monitoring of lesions. Glioma is the most common optic nerve tumor in children. MATERIAL Articles in PubMed, Scholar and Website were reviewed, taking into account current standards of management related to sporadic or NF1-related optic glioma, epidemiology, location, course of the disease, clinical manifestations, histological types of the tumor, genetic predisposition, diagnostic ophthalmic tests currently applicable in therapeutic monitoring of the tumor, neurological diagnosis, therapeutic management and prognosis. The importance of current screening recommendations, in line with standards, was emphasized. RESULTS Glioma occurs in children most often in the first decade of life. Initially, they may be asymptomatic, and clinically ophthalmic changes are associated with the organ of vision or with systemic changes. Gliomas associated with the NF1 mutation have a better prognosis for sporadic gliomas. Diagnosis includes radiological imaging methods/MRI/ophthalmology/OCT and visual acuity log MAR assessment. The basis of treatment is clinical observation. In the case of disease progression, surgical treatment, chemotherapy and targeted therapy are used. CONCLUSION Further research into novel techniques for detecting gliomas would allow for early monitoring of the disease.
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Affiliation(s)
- Monika Modrzejewska
- II Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Joanna Olejnik-Wojciechowska
- Scientific Students Association of Ophtalmology, II Department of Ophthalmology, Pomeranian Medical University, Szczecin Unia Lubelska 1 Street, 71-252 Szczecin, Poland
| | - Agnieszka Roszyk
- Scientific Students Association of Ophtalmology, II Department of Ophthalmology, Pomeranian Medical University, Szczecin Unia Lubelska 1 Street, 71-252 Szczecin, Poland
| | - Elwira Szychot
- Department of Paediatrics, Oncology and Paediatric Immunology, Pomeranian Medical University, 71-252 Szczecin, Poland
- Department of Paediatric Onclogy, Great Ormond Street Hospital for Children, London WC1N 1LE, UK
| | - Tomasz Dariusz Konczak
- Department of Paediatrics, Oncology and Paediatric Immunology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Marcin Szemitko
- Department of Intervantional Radiology, Pomerian Medical University, 70-111 Szczecin, Poland
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Grippin AJ, McGovern SL. Proton therapy for pediatric diencephalic tumors. Front Oncol 2023; 13:1123082. [PMID: 37213290 PMCID: PMC10196353 DOI: 10.3389/fonc.2023.1123082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/03/2023] [Indexed: 05/23/2023] Open
Abstract
Diencephalic tumors tend to be low grade tumors located near several critical structures, including the optic nerves, optic chiasm, pituitary, hypothalamus, Circle of Willis, and hippocampi. In children, damage to these structures can impact physical and cognitive development over time. Thus, the goal of radiotherapy is to maximize long term survival while minimizing late effects, including endocrine disruption leading to precocious puberty, height loss, hypogonadotropic hypogonadism, and primary amenorrhea; visual disruption including blindness; and vascular damage resulting in cerebral vasculopathy. Compared to photon therapy, proton therapy offers the potential to decrease unnecessary dose to these critical structures while maintaining adequate dose to the tumor. In this article, we review the acute and chronic toxicities associated with radiation for pediatric diencephalic tumors, focusing on the use of proton therapy to minimize treatment-related morbidity. Emerging strategies to further reduce radiation dose to critical structures will also be considered.
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Samples DC, Mulcahy Levy JM, Hankinson TC. Neurosurgery for Optic Pathway Glioma: Optimizing Multidisciplinary Management. Front Surg 2022; 9:884250. [PMID: 35599811 PMCID: PMC9114802 DOI: 10.3389/fsurg.2022.884250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Optic pathway glioma (OPG) comprises 10% of pediatric brain tumors and 40% of all pediatric low-grade gliomas (pLGGs). While generally considered benign pathologically, many require interventions with chemotherapy, radiation, or targeted therapies. Management has historically foregone tissue diagnosis given the classical clinical/radiographic presentation of these tumors, inability to safely remove the lesions surgically, and efficacy and safety of available chemotherapy options. Furthermore, when considering such aspects as their delicate location, the role of surgery continues to be heavily debated. More recently, however, a greater understanding of the genetic drivers of OPGs has made operative tissue sampling a critical step in management planning, specifically for patients without Neurofibromatosis, Type I (NF1). Given the need for long-term, complex management of pediatric OPGs, it is crucial that a multidisciplinary approach is employed, and the rapidly expanding role of molecular characterization be incorporated into their management.
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Affiliation(s)
- Derek C. Samples
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO, United States
- Correspondence: Derek C. Samples
| | - Jean M. Mulcahy Levy
- Department of Pediatrics (Center for Cancer and Blood Disorders), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States
| | - Todd C. Hankinson
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO, United States
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States
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Howden K, Chapman S, Serletis D, Kazina C, Rafay MF, Faury D, Hazrati LN, Jabado N, Vanan MI. Management of Inoperable Supra-Sellar Low-Grade Glioma With BRAF Mutation in Young Children. Cureus 2021; 13:e19400. [PMID: 34926002 PMCID: PMC8656291 DOI: 10.7759/cureus.19400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/04/2022] Open
Abstract
Pediatric low-grade gliomas (PLGGs) are the most common central nervous system (CNS) tumors in children. The current standard of care for surgically unresectable and/or progressive cases of PLGGs includes combination chemotherapy. PLGGs are molecularly characterized by alterations in the RAS/RAF/MAPK/ERK pathway in a majority of tumors. PLGGs harboring the BRAF-V600E mutation respond poorly to current chemotherapy strategies. We present a case of a two-year-old female with biopsy-proven low-grade glioma (LGG, pilocytic astrocytoma) involving the hypothalamic/optic chiasm region. At presentation, she had obstructive hydrocephalus, bitemporal hemianopia, central hypothyroidism, and right-sided hemiparesis due to the location/mass effect of the tumor. She was initially treated with chemotherapy (vincristine/carboplatin), but her tumor progressed at six weeks of treatment. She was subsequently started on dabrafenib as her tumor was positive for BRAF-V600E mutation. Dabrafenib monotherapy resulted in dramatic improvement in her clinical symptoms and near-complete resolution of tumor. Our experience and review of the literature suggest that LGGs with BRAF-V600E mutations may benefit from upfront targeted therapy in children. There is an urgent need for prospective clinical trials comparing the efficacy of upfront BRAF inhibitors versus standard chemotherapy in PLGGs with BRAF mutations.
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Affiliation(s)
- Kaitlyn Howden
- Section of General Pediatrics, Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Stacy Chapman
- Section of Pediatric Hematology-Oncology, Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
| | - Demitre Serletis
- Section of Neurosurgery, Department of Surgery, Winnipeg Children's Hospital, University of Manitoba, Winnipeg, CAN
| | - Colin Kazina
- Section of Neurosurgery, Department of Surgery, Winnipeg Children's Hospital, University of Manitoba, Winnipeg, CAN
| | - Mubeen F Rafay
- Section of Neurology, Department of Pediatrics and Child Health, Winnipeg Children's Hospital, University of Manitoba, Winnipeg, CAN
| | - Damien Faury
- Section of Pediatric Hematology-Oncology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, CAN
| | - Lili-Naz Hazrati
- Section of Neuropathology, Department of Pathology, The Hospital for Sick Children, University of Toronto, Toronto, CAN
| | - Nada Jabado
- Section of Pediatric Hematology-Oncology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, CAN
| | - Magimairajan Issai Vanan
- Section of Pediatric Hematology-Oncology, Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, CAN
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Walker DA, Azizi AA, Liu JF, Sehested A, Jaspan T, Pemp B, Simmons I, Ferner R, Grill J, Hargrave D, Driever PH, Evans DG, Opocher E. Regarding "Neuro-Oncology Practice Clinical Debate: targeted therapy vs conventional chemotherapy in pediatric low-grade glioma". Neurooncol Pract 2020; 7:572-573. [PMID: 33014399 DOI: 10.1093/nop/npaa031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, UK
| | - Amedeo A Azizi
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - Jo-Fen Liu
- Children's Brain Tumour Research Centre, University of Nottingham, UK
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Timothy Jaspan
- Department of Radiology, Nottingham University Hospitals NHS Trust, UK
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Ian Simmons
- Department of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rosalie Ferner
- Department of Neurology Guy's and St. Thomas' NHS Foundation Trust and IoPPN, King's College London, London, UK
| | - Jacques Grill
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Darren Hargrave
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - D Gareth Evans
- Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Enrico Opocher
- Department of Pediatrics, University of Padua, Padua, Italy
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