Brainstem gliomas (BSG) with intrinsic and extensive brainstem involvement continue to have a poor outlook despite current treatment approaches. Neuroimaging studies have aided in the differentiation of malignant brainstem tumors from more ‘benign’ subgroups. A Children’s Cancer Group protocol evaluating outcome in children with BSG after treatment with hyperfractionated radiotherapy (7,200–7,800 cGy) was recently completed. The clinical aspects of 119 children entered into this study were reviewed in an attempt to determine risk groups and prognostic indicators. The overall survival of this group was very poor and there was no statistically significant correlation of survival with age, sex, clinical symptoms and signs, or tumor grade. Longer survival was only associated with prolonged duration of brainstem symptoms and signs greater than 1 month prior to diagnosis of the tumor. Improved outlook for children with BSG will require further research in tumor biology and newer therapeutic modalities.

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