INFANT-TYPE HEMISPHERIC GLIOMA: CAN IT BE EFFECTIVELY MANAGED IN AN UPPER-MIDDLE-INCOME COUNTRY?

BACKGROUND Infant-type hemispheric glioma (IHGs) is a rare congenital tumor and a newly defined entity in the 2021 WHO classification for central nervous system tumors. It harbors, in mostly cases, a tyrosine kinase receptor rearrangement in NTRK family, ALK, ROS1 and MET. The aim of this study is to describe the demographic characteristics, treatment, and outcomes of a cohort of pediatric patients with IHGs in one single institution. METHODS A retrospective study was performed between 2012-2023. Overall survival (OS) was measured from diagnosis to date of death or last follow-up. The Kaplan–Meier method was used for survival analysis. RESULTS Fourteen patients were included. Median age was 4.4 months (range 0.1- 37months). All patients underwent neurosurgical resections, with a median of 2 (range 1-6). Eight patients performed molecular analyses showing three ALK, two NTRK, two ROS and one MET rearrangement. Twelve patients received chemotherapy-lines, four of them more than one schema, with a median of 3 (range 2-5). Three patients were submitted to focal radiotherapy after 3 years of age and three received target therapies (crizotinib/ alectinib, lolartinib and repotrectinib). In a median follow-up of 46.9 months (2-125months), the OS in 5/10 years was 73.9% and 55.4%, respectively. Four patients died, one due to neurosurgical complications at diagnosis, one from refractory seizure 47 months after diagnosis with no evidence of disease, and two due disease progression with eight and 74 months after initial diagnosis, the last one despite 2-lines of target therapy. CONCLUSION Our series reveals acceptable and encouraging survival rates, demonstrating that not only new molecular discoveries but also optimal multidisciplinary treatment makes a difference in survival of patients with IHG even in countries with limited resources. However, access to targeted therapy remains an obstacle to be overcome for the optimal management of these patients.