Prognostic Factors for Survival in Pediatric Diffuse Midline Gliomas: The Importance of T2 FLAIR Missmatch Sign and Nimotuzumab Therapy

Abstract

Purpose: The aim of this study is to investigate the clinical and radiological features, especially the importance of the T2-FLAIR mismatch sign and the response to treatment of patients diagnosed with diffuse midline gliomas (DMG) in our center. Methods: Eighteen patients treated with a diagnosis of DMG between January 2008 and January 2021 in Gazi University Medical Faculty, Department of Pediatric Oncology were retrospectively evaluated. The radiologycal evaluation was made as T2-FLAIR mismatch sign positive or negative. After a tumor board review, the diagnosis of DMG was made clinically and radiologically and all patients received local radiotherapy. Nimotuzumab was given as monotherapy or in combination with other medications Results: T2-FLAIR mismatch sign was positive for twelve patients and median OS for patients with T2-FLAIR mismatch positive and negative were 12.5 months and 9.2 months respectively (p=0.77). Median PFS for patients with T2-FLAIR mismatch sign positive and negative were 10.6 months and 4.8 months respectively (p=0.84). After nimotuzumab therapy, there was 4 cases with PR (44.4%), and 1 patient with SD (11.1%). Median OS for patients who were treated with and without nimotuzumab were 16.5 and 6.2 months respectively (p<0.05). Median PFS for patients who were treated with and without nimotuzumab were 13.3 and 3.7 months respectively (p<0.05). Conclusion: In conclusion, DMGs have poor prognosis. In our study patients with T2-FLAIR mismatch sign positive had better prognosis so it can be used as an imaging marker for prognosis. Nimotuzumab therapy may be a promising treatment option for DMG.