Multimodal treatment strategy in a pediatric case of diffuse pontine glioma: case report

Abstract

Background. Diffuse pontine glioma is a rare, rapidly progressing malignant tumor with a poor prognosis. Radiotherapy is the initial standard treatment, but its effect is limited, and conventional chemotherapy is ineffective. Combined therapies with immunotherapy are being explored to improve tumor control. Objective(s). The paper presents the course and multimodal treatment of a diffuse pontomesencephalic glioma, highlighting the challenges of radiotherapy, chemotherapy, immunotherapy and the outcomes achieved. Materials and methods. This case report presents a pediatric patient diagnosed in June 2024 with a tumor located in the brainstem, specifically the pons and midbrain. The clinical data, imaging studies (MRI), and therapeutic interventions were retrospectively gathered from medical records and family reports, within the IMSP Oncological Institute. Results. The patient diagnosed in June 2024 with a brainstem tumor presented with gait instability, vomiting, and facial palsy. MRI showed a large mass compressing the fourth ventricle. She received radiotherapy (54 Gy), temozolomide, and immunotherapy. After 8 immunotherapy sessions and 3 chemotherapy cycles, MRI showed tumor stability. Following relocation to the Netherlands, immunotherapy was stopped. Two months later, right hemiparesis and tumor progression with thrombosis developed. Stereotactic radiotherapy, anticoagulants, resumption of immunotherapy, and increased dexamethasone dose were applied, leading to neurological improvement. Conclusion(s). The multimodal therapy (RT + ChT + immunotherapy) provided temporary stabilization, but subsequent progression confirmed the disease’s aggressiveness. Although nimotuzumab was well tolerated, its impact was limited. Innovative strategies are needed to improve survival.