Institutional Patterns of Care of Diffuse Intrinsic Pontine Glioma

• Published in: Neurology India Vol. 71; no. 1; pp. 72 - 78
• Main Authors: Krishnatry, Rahul, Mani, Shakthivel, Manjali, Jifmi J., Rane, Pallavi P., Chatterjee, Abhishek, Goda, Jayant S., Janu, Amit, Sahu, Arpita, Gupta, Tejpal, Jalali, Rakesh
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow 2023; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd
• Edition: 2
• Subjects: Academies and Institutes; Biopsy; Brain; Brain cancer; Care and treatment; Diagnosis; Diffuse Intrinsic Pontine Glioma; Glioma; Gliomas; Glossopharyngeal Nerve; Humans; Medical prognosis; Nervous system; Original Article; Patient outcomes; Progression-Free Survival; Radiation therapy; Radiotherapy; Retrospective Studies; Steroids; Surgery; Survival analysis; India; radiotherapy; steroids; re-irradiation; Diffuse intrinsic pontine glioma
• ISSN: 0028-3886; 1998-4022
• DOI: 10.4103/0028-3886.370459

Background and Aim: Despite recent advances, the outcomes of diffuse intrinsic pontine glioma (DIPG) remain dismal. This is a retrospective study to understand the pattern of care and its impact on DIPG patients diagnosed over 5 years in a single institute. Subjects and Methods: DIPGs diagnosed between 2015 and 2019 were retrospectively reviewed to understand the demographics, clinical features, patterns of care, and outcomes. The usage of steroids and response to treatment were analyzed as per the available records and criteria. The re-irradiation cohort was propensity matched with patients with a progression-free survival (PFS) >6 months treated with supportive care alone based on PFS and age as a continuous variable. Survival analysis was performed using the Kaplan-Meier method, and Cox regression model was used to identify any potential prognostic factors. Results: One hundred and eighty-four patients were identified with demographic profiles similar to western population-based data in the literature. Of them, 42.4% were residents from outside the state of the institution. About 75.2% of patients completed their first radiotherapy treatment, of which only 5% and 6% had worsening clinical symptoms and persistent need for steroids 1 month posttreatment. On multivariate analysis, Lansky performance status <60 (P = 0.028) and cranial nerve IX and X (P = 0.026) involvement were associated with poor survival outcomes while receiving radiotherapy with better survival (P < 0.001). In the cohort of patients receiving radiotherapy, only re-irradiation (reRT) was associated with improved survival (P = 0.002). Conclusion: Many patient families still do not choose radiotherapy treatment, although it has a consistent and significant positive association with survival and steroid usage. reRT further improves outcomes in the selective cohorts. Involvement of cranial nerves IX and X needs improved care.