Treatment of Progressive Brain Stem Glioma With Bevacizumab: Radiological, Metabolic and Histopathological Aspects^[*]

Introduction

Brain stem gliomas in adults are rare (about 2% of all brain tumors) and little is known about their biological behavior, clinical course, and optimal treatment strategy.[5] Additionally, reports about brain stem gliomas in adults are often based on radiological features without histopathological confirmation of the diagnosis. In contrast to pediatric brain stem gliomas, which have a typical radiological appearance, there is a wide range of differential diagnoses for lesions within the brain stem in adults: intrinsic brain tumors, metastasis, abscess, encephalitis, lymphoma, demyelinating disorders, and infarction. Therefore the histological confirmation of a brain stem glioma is a precondition for any treatment decision, including radiation- or chemotherapy and administration of second-line chemotherapeutic agents like bevacizumab. In this paper, we report the radiological, metabolic, and clinical effects of treatment with bevacizumab for a histologically proven brain stem glioma (astrocytoma WHO II), which was progressive after radiation therapy and chemotherapy with temozolomide. The relevance of the molecular biological features like the MGMT status and the VEGF expression for treatment decisions are also discussed.

^* This article was originally published online in Central European Neurosurgery on November 2, 2011 (DOI:10.1055/s-0031-1275692)

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