TY - JOUR
T1 - MRI and Molecular Characterization of Pediatric High-Grade Midline Thalamic Gliomas
T2 - The HERBY Phase II Trial
AU - Rodriguez, Daniel
AU - Calmon, Raphael
AU - Aliaga, Esther Sanchez
AU - Warren, Daniel
AU - Warmuth-Metz, Monika
AU - Jones, Chris
AU - Mackay, Alan
AU - Varlet, Pascale
AU - Le Deley, Marie-Cécile
AU - Hargrave, Darren
AU - Cañete, Adela
AU - Massimino, Maura
AU - Azizi, Amedeo A
AU - Saran, Frank
AU - Zahlmann, Gudrun
AU - Garcia, Josep
AU - Vassal, Gilles
AU - Grill, Jacques
AU - Peet, Andrew
AU - Dineen, Robert A
AU - Morgan, Paul S
AU - Jaspan, Timothy
N1 - Funding Information: Acknowledgments: We acknowledge the help and support for this research from the following bodies: the Australian Children’s Cancer Trust (ACCT), Innovative Therapies for Children with Cancer (ITCC), and European Society for Paediatric Oncology (SIOPE). All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the UK NIHR Great Ormond Street Hospital Biomedical Research Centre. NHS funding to the National Institute for Health Research Biomedical Research Centre at The Royal Marsden and the ICR. P.S.M. and R.A.D. are members of the UK National Institute of Health Research’s Nottingham Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Funding Information: Supported by F. Hoffman-La Roche (study number B025041; ClinicalTrials.gov identifier NCT01390948). Conflicts of interest are listed at the end of this article. See also the editorial by Widjaja in this issue. Publisher Copyright: © RSNA, 2022.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Background: Diffuse midline gliomas (DMG) are characterized by a high incidence of H3 K27 mutations and poorer outcome. The HERBY trial has provided one of the largest cohorts of pediatric DMGs with available radiologic, histologic-genotypic, and survival data. Purpose: To define MRI and molecular characteristics of DMG. Materials and Methods: This study is a secondary analysis of a prospective trial (HERBY; ClinicalTrials.gov identifier, NCT01390948) undertaken between October 2011 and February 2016. Among 121 HERBY participants, 50 had midline nonpontine-based tumors. Midline high-grade gliomas were reclassified into DMG H3 K27 mutant, H3 wild type with enhancer of zest homologs inhibitory protein overexpression, epidermal growth factor receptor mutant, or not otherwise stated. The epicenter of each tumor and other radiologic characteristics were ascertained from MRI and correlated with the new subtype classification, histopathologic characteristics, surgical extent, and outcome parameters. Kaplan-Meier curves and log-rank tests were applied to determine and describe survival differences between groups. Results: There were 42 participants (mean age, 12 years 6 4 [SD]; 23 girls) with radiologically evaluable thalamic-based DMG. Eighteen had partial thalamic involvement (12 thalamopulvinar, six anteromedial), 10 involved a whole thalamus, nine had unithalamic tumors with diffuse contiguous extension, and five had bithalamic tumors (two symmetric, three partial). Twenty-eight participants had DMG H3 K27 mutant tumors; there were no differences in outcome compared with other DMGs (n = 4). Participants who underwent major debulking or total or near-total resection had longer overall survival (OS): 18.5 months vs 11.4 months (P = .02). Enrolled participants who developed leptomeningeal metastatic dissemination before starting treatment had worse outcomes (event-free survival, 2.9 months vs 8.0 months [P = .02]; OS, 11.4 months vs 18.5 months [P = .004]). Conclusion: Thalamic involvement of diffuse midline gliomas ranged from localized partial thalamic to holo- or bithalamic with diffuse contiguous spread and had poor outcomes, irrespective of H3 K27 subtype alterations. Leptomeningeal dissemination and less than 50% surgical resection were adverse risk factors for survival.
AB - Background: Diffuse midline gliomas (DMG) are characterized by a high incidence of H3 K27 mutations and poorer outcome. The HERBY trial has provided one of the largest cohorts of pediatric DMGs with available radiologic, histologic-genotypic, and survival data. Purpose: To define MRI and molecular characteristics of DMG. Materials and Methods: This study is a secondary analysis of a prospective trial (HERBY; ClinicalTrials.gov identifier, NCT01390948) undertaken between October 2011 and February 2016. Among 121 HERBY participants, 50 had midline nonpontine-based tumors. Midline high-grade gliomas were reclassified into DMG H3 K27 mutant, H3 wild type with enhancer of zest homologs inhibitory protein overexpression, epidermal growth factor receptor mutant, or not otherwise stated. The epicenter of each tumor and other radiologic characteristics were ascertained from MRI and correlated with the new subtype classification, histopathologic characteristics, surgical extent, and outcome parameters. Kaplan-Meier curves and log-rank tests were applied to determine and describe survival differences between groups. Results: There were 42 participants (mean age, 12 years 6 4 [SD]; 23 girls) with radiologically evaluable thalamic-based DMG. Eighteen had partial thalamic involvement (12 thalamopulvinar, six anteromedial), 10 involved a whole thalamus, nine had unithalamic tumors with diffuse contiguous extension, and five had bithalamic tumors (two symmetric, three partial). Twenty-eight participants had DMG H3 K27 mutant tumors; there were no differences in outcome compared with other DMGs (n = 4). Participants who underwent major debulking or total or near-total resection had longer overall survival (OS): 18.5 months vs 11.4 months (P = .02). Enrolled participants who developed leptomeningeal metastatic dissemination before starting treatment had worse outcomes (event-free survival, 2.9 months vs 8.0 months [P = .02]; OS, 11.4 months vs 18.5 months [P = .004]). Conclusion: Thalamic involvement of diffuse midline gliomas ranged from localized partial thalamic to holo- or bithalamic with diffuse contiguous spread and had poor outcomes, irrespective of H3 K27 subtype alterations. Leptomeningeal dissemination and less than 50% surgical resection were adverse risk factors for survival.
UR - http://www.scopus.com/inward/record.url?scp=85132456150&partnerID=8YFLogxK
U2 - https://doi.org/10.1148/radiol.211464
DO - https://doi.org/10.1148/radiol.211464
M3 - Article
C2 - 35412366
SN - 0033-8419
VL - 304
SP - 174
EP - 182
JO - Radiology
JF - Radiology
IS - 1
ER -