Prognostic factors in brainstem gliomas

Although brainstem gliomas carry the worst prognosis of any brain tumor in children, with median survivals of 9 to 12 months, there may be a subgroup of long-term survivors. We have identified 12 children with brainstem gliomas, 5 of whom have survived greater than 6 years and 6 less than or equal to 12 months. Another child, alive and well 3 years following diagnosis, was considered in the long-term survivor group. Favorable prognostic factors included neurofibromatosis, symptoms greater than or equal to 12 months before diagnosis, calcification on CT, exophytic location, and pathology suggesting a low-grade tumor. Recognition that certain patients with brainstem gliomas may have prolonged survivals even in the absence of definitive treatment must be taken into consideration when new treatment regimens are being formulated.