Needle-track metastasis in DIPG: need for a standardized surgical strategy?

Abstract Background Diffuse intrinsic pontine glioma (DIPG) remains uniformly lethal. Stereotactic biopsy confirms the diagnosis and enables molecular profiling. Metastasis along the biopsy track (BTM) has been reported only anecdotally; its prevalence, clinical relevance, and implications for treatment remain unclear. Methods A multicenter retrospective study in patients with confirmed DIPG and BTM was conducted based on central neuroradiologic review. Radiotherapy schedules were re-assessed to evaluate the feasibility of upfront biopsy track irradiation. Results Ten children met inclusion criteria (median age 6.8 years). Biopsy route was supratentorial in six and infratentorial in four children, and side-cutting needles were used predominantly. H3F3A mutations were most frequent (n = 8); TP53 alterations were common in tumors with extended molecular profiling available. Median PFS was 8.1 months. Five patients each developed BTM prior to (median 2.7 months) or concurrently with progression of primary tumor. There was no difference in overall survival (median OS 12.0 months) compared with the reference cohort. Estimated BTM prevalence among biopsied DIPG from additional registry data was between 6.9% and 13.0%. Primary biopsy track irradiation proved to be feasible, and comparing the surgical access routes, the infratentorial biopsy track hardly increased radiation exposure of the whole brain. Conclusions Needle track metastasis is a rare progression pattern in stereotactic biopsied DIPG. Upfront irradiation of the biopsy track may represent a strategy to mitigate the potential risk of BTM. From a dosimetric perspective, an infratentorial approach may therefore be considered, as it was associated with only marginally increased radiation exposure.

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Journal
Neuro-Oncology Advances
Published
2026-06-08
DOI
https://doi.org/10.1093/noajnl/vdag155
Primary Topic
Glioma Diagnosis and Treatment
Type
article
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article

Needle-track metastasis in DIPG: need for a standardized surgical strategy?

Giovanna Stefania Colafati, Gerrit H. Gielen, Axel Karow, Martin Benesch et al.
Neuro-Oncology Advances
Glioma Diagnosis and Treatment
article

Needle-track metastasis in DIPG: need for a standardized surgical strategy?

Giovanna Stefania Colafati, Gerrit H. Gielen, Axel Karow, Martin Benesch, Christof M. Kramm, C Rödel, Brigitte Bison, Dorothee Cäcilia Spille, Friederike Knerlich‐Lukoschus, Valentina Di Ruscio, T. Giandini, Lucia De Martino, Thomas Perwein, Veronica Biassoni, Michael Karremann, Sebastian Makocki, Emilia Pecori, Silvia Chiesa, Elisabetta Schiavello, Sergiu Scobioala, Thorsten Simon, Anna Cavallo, Gunther Nussbaumer, Hans Christoph Bock, Karolina Jabłońska, Martin Demmert, Arianna Trovò, Angela Mastronuzzi, K Kerl, Sabina Vennarini, Mechthild Krause, Lea L Friker, Vicente Santa-Maria Lopez, Dirk Rades, André O von Bueren, Marion Hoffmann, Olga Nigro, Andrea Carai, Torsten Pietsch, Anke Barnbrock, Andrés Morales-La Madrid, Jeanne-Marie Franke, Ulrich-Wilhelm Thomale, Maura Massimino, Rudolph Schwarz, Chiara Valentini
article en

Abstract

Abstract Background Diffuse intrinsic pontine glioma (DIPG) remains uniformly lethal. Stereotactic biopsy confirms the diagnosis and enables molecular profiling. Metastasis along the biopsy track (BTM) has been reported only anecdotally; its prevalence, clinical relevance, and implications for treatment remain unclear. Methods A multicenter retrospective study in patients with confirmed DIPG and BTM was conducted based on central neuroradiologic review. Radiotherapy schedules were re-assessed to evaluate the feasibility of upfront biopsy track irradiation. Results Ten children met inclusion criteria (median age 6.8 years). Biopsy route was supratentorial in six and infratentorial in four children, and side-cutting needles were used predominantly. H3F3A mutations were most frequent (n = 8); TP53 alterations were common in tumors with extended molecular profiling available. Median PFS was 8.1 months. Five patients each developed BTM prior to (median 2.7 months) or concurrently with progression of primary tumor. There was no difference in overall survival (median OS 12.0 months) compared with the reference cohort. Estimated BTM prevalence among biopsied DIPG from additional registry data was between 6.9% and 13.0%. Primary biopsy track irradiation proved to be feasible, and comparing the surgical access routes, the infratentorial biopsy track hardly increased radiation exposure of the whole brain. Conclusions Needle track metastasis is a rare progression pattern in stereotactic biopsied DIPG. Upfront irradiation of the biopsy track may represent a strategy to mitigate the potential risk of BTM. From a dosimetric perspective, an infratentorial approach may therefore be considered, as it was associated with only marginally increased radiation exposure.

Neuro-Oncology Advances
Università Cattolica del Sacro Cuore (IT), Goethe University Frankfurt (DE), University of Geneva (CH), Hospital Sant Joan de Déu Barcelona (ES), Universität Hamburg (DE), University of Augsburg (DE), German Cancer Research Center (DE), University of Cologne (DE), Medical University of Graz (AT), Heidelberg University (DE), University Hospital Bonn (DE), Helmholtz-Zentrum Dresden-Rossendorf (DE), University Hospital Augsburg (DE), University Hospital Heidelberg (DE), Universitätsklinikum Erlangen (DE), Düsseldorf University Hospital (DE), Institute for Integrative and Experimental Genomics (DE), Integrated Oncology (United States) (US), Advanced Radiation Therapy (United States) (US), University Hospital Münster (DE), University Hospital of Geneva (CH), University Medical Center Hamburg-Eppendorf (DE), National Center for Tumor Diseases (DE), University Hospital Schleswig-Holstein (DE), Universitätsmedizin Göttingen (DE), Nephrologisches Zentrum Goettingen (DE), Bambino Gesù Children's Hospital (IT), Santobono Children's Hospital (IT), University Hospital Frankfurt (DE), University Hospital Cologne (DE), University Medical Centre Mannheim (DE), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), University Hospital Carl Gustav Carus (DE), Life & Brain (Germany) (DE), Heinrich Heine University Düsseldorf (DE), Frankfurt University of Applied Sciences (DE), Geneva College (US), University of Göttingen (DE), Charité - Universitätsmedizin Berlin (DE), University of Lübeck (DE)
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