Pediatric diffuse midline gliomas are a type of brain tumor that is a leading cause of childhood cancer-related deaths. These tumors typically develop in critical midline structures of the brain, such as the brainstem, cervical spinal cord, and other crucial regions that are challenging to access during surgery.
Due to the intricate location of these tumors, known previously as diffuse intrinsic pontine gliomas (DIPG), the primary treatment approach has been focused radiation therapy. This technique involves directing radiation precisely to the specific area where the tumor is situated.
Unlike other pediatric brain cancers, which often require radiation therapy to the entire brain and spinal cord to prevent cancer spread, diffuse midline gliomas have been treated differently. This is mainly because of their highly aggressive nature and the fact that craniospinal radiation is more toxic and time-consuming to administer.
Although these tumors can spread to other parts of the brain and spinal cord, the primary concern has been the local recurrence of the tumor. Unfortunately, the majority of children with diffuse midline gliomas succumb to the disease before metastatic spread becomes a significant factor. This emphasizes the urgent need to address tumor recurrence within the local region.
Emerging Challenges in Treating Pediatric Diffuse Midline Gliomas
In recent times, medical professionals have achieved notable advancements in the treatment of diffuse midline gliomas by directly administering chemotherapy through catheters to target the tumor. However, this positive development has given rise to a new challenge—some patients now survive longer, leading to the development of metastatic disease that ultimately proves fatal. Addressing this concern, Dr. Green and other members of the University of Colorado Cancer Center have conducted research published in Frontiers in Oncology, proposing a dual-treatment approach that shows promise in controlling metastasis in diffuse midline gliomas.
Using animal models, the researchers compared different treatment strategies: focal radiation solely to the tumor, radiation to the entire brain and spinal cord along with a focal radiation boost to the tumor, or no radiation at all. The findings revealed that while focal radiation initially caused tumor shrinkage in the brain, the tumors eventually regrew, and the animals developed metastatic disease. In the models treated with craniospinal radiation combined with a boost to the tumor area, tumor regrowth occurred similarly to current patient cases. However, a significant number of these models did not develop metastatic disease in either the brain or spinal cord. Dr. Green, who provides patient care at Children’s Hospital Colorado, highlights the potential of this treatment approach in managing metastasis and improving outcomes for diffuse midline glioma patients.
Seeking the Optimal Treatment Combination
The key takeaway from the research is that craniospinal radiation appears to be a valuable adjunct to the treatment of diffuse midline gliomas, effectively preventing the cancer from spreading to other areas of the central nervous system. Building upon these findings, the researchers are now planning to investigate additional combinations of treatments, including radiation, chemotherapy, and immunotherapy, in order to determine the most effective approach.
The ultimate goal is to achieve long-term survival for patients, surpassing the temporary responses observed with current treatments. Dr. Green expresses optimism, stating that their aim is to incorporate these potentially successful treatment combinations across various modalities into a comprehensive multimodality trial. Such a trial could yield a curative effect for patients diagnosed with diffuse midline gliomas.
Impressive Advancements
This groundbreaking research marks significant advancements in the treatment of a deadly childhood cancer that has remained unchanged since the 1960s, when the daughter of astronaut Neil Armstrong succumbed to diffuse midline glioma.
For six decades, patients have been receiving the exact same treatment that was administered to Armstrong’s daughter. Dr. Green emphasizes the profound impact this has on families who receive the devastating news of their child’s cancer diagnosis. While we can often provide potentially curative treatment options for many other types of cancer, this particular disease lacks such options. Despite the chances varying across different cancers, even the ones with lower probabilities of cure still offer some hope. Unfortunately, in this particular disease, we have yet to recommend any potentially curative treatment plan.
The ultimate objective of this research, if successful, is to combine these treatment approaches into comprehensive regimens akin to those available for other childhood cancers. This pioneering effort aims to offer a newfound sense of hope for a cure to patients facing this disease, potentially for the first time.