Radiotherapy in the management of diffuse intrinsic pontine glioma- Three clinical cases with literature review

Diffuse intrinsic pontine glioma (DIPG) is an aggressive primary pediatric brain tumor. Typical DIPG was defined radiographically as a poorly defined tumor with mass effect occupying ≥75% of the pontine axial diameter that was hypointense on T1-weighted MR images and hyperintense on T2-weighted images. We present three children with DIPG after radiotherapy (RT) in order to expand the knowledge of this aggressive brain tumor and to emphasize the main role of the radiation method in its treatment. Our observations from the realized RT are that despite highly risky tumor localization, conventional and hypophractionated RT are well tolerated, without acute neurological toxicity and allow second irradiation /re-irradiation, due to local tumor progression. The atypical MRI image of the pontine tumors requires a stereotaxic biopsy or spectroscopic MRI. With a biopsy or MRI data on undifferential malignant tumor such as glioblastoma and meduloblastoma, radiation strategy is much more accurately assessed, as well as the need for craniospinal RT.