{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T14:32:36Z","timestamp":1778337156634,"version":"3.51.4"},"reference-count":50,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,11,27]],"date-time":"2019-11-27T00:00:00Z","timestamp":1574812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2020,6,15]]},"abstract":"<jats:p>Reports on pediatric low\u2010grade glioma (LGG) of the caudal brainstem are retrospective with heterogeneous cohorts, variable treatments and inconsistent outcome data. We analyzed their natural history and asked whether brainstem location proved unfavorable for survival within the framework of the comprehensive SIOP\u2010LGG 2004 management strategy. Within the prospectively registered, population\u2010based German SIOP\u2010LGG 2004 cohort 116 patients (age 0.2\u201316.5\u2009years, 10% Neurofibromatosis NF1) were diagnosed with LGG of the pons (27%) and medulla oblongata (73%). After biopsy (23%), variable resection (63%) or radiologic diagnosis only (14%), 59 patients received no adjuvant treatment. Radiologic progression or severe neurologic symptoms prompted chemo\u2010 (<jats:italic>n<\/jats:italic> = 39) or radiotherapy (<jats:italic>n<\/jats:italic> = 18). After further progression (28\/57), salvage treatments included multiple treatment lines for 12\/28 patients. Five\u2010years event\u2010free survival dropped to 0.40, while 5\u2010years overall survival was 0.95 (median observation time 6.8\u2009years). Higher extent of resection yielded lower progression rate (<jats:italic>p<\/jats:italic> = 0.001), but at a cost of 21\/100 patients suffering from new postsurgical complications including respiratory insufficiency. Central review confirmed pilocytic astrocytoma (56%), diffuse astrocytoma (8%) or glioneuronal histology (16%) (others 4%, no histology 17%). Malignant evolution was documented in five patients associated with Histone3 mutation in 2\/5. Our treatment algorithm conveyed high overall survival for pediatric brainstem LGG. Extensive neurosurgical resection did increase additional postoperative neurologic deficits but not overall survival in this often\u2010chronic disease. More than half of all patients can be safely followed by observation, while multimodal adjuvant treatment can control progressive tumors. Molecular assessment should confirm low\u2010grade diagnosis and may detect patterns prognostic for malignant evolution.<\/jats:p>","DOI":"10.1002\/ijc.32734","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T22:47:23Z","timestamp":1571179643000},"page":"3385-3396","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Favorable prognosis in pediatric brainstem low\u2010grade glioma: Report from the German SIOP\u2010LGG 2004 cohort"],"prefix":"10.1002","volume":"146","author":[{"given":"Johannes","family":"Holzapfel","sequence":"first","affiliation":[{"name":"Swabian Children's Cancer Center University Hospital Augsburg  Augsburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Kandels","sequence":"additional","affiliation":[{"name":"Swabian Children's Cancer Center University Hospital Augsburg  Augsburg 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