Journal Watch (continued)

“The lack of tumour tissue has led to stagnation in biological and genetic studies.”

The paper’s main focus was in understanding problems in overcoming the lack of specimens for analysis of DIPGs. The authors did identify that recent reports indicate “that biopsies in DIPG are safe and performed with acceptable low and only transient morbities while accomplishing meaningful analysis.” However, they also felt that using living tissue is ‘most defensible’ once there are therapeutic options in which the patient will benefit from in obtaining such samples.
The authors report on post-mortem tumor examination to try to get out of this catch 22 situation (one can only do a biopsy if there is benefit to the individual however one will not uncover those things that might be of benefit without tissue).
In regards to the 9 donations-

• Eight of the children died at home.
• Two children (age 10 and 11) expressed their own wish to donate.
• No parent expressed regret in donation.
• All families were offered disclosure of the autopsy result.

Although the numbers are very small, the paper is of significance in highlighting that such a program can be untaken— even with such logistical difficulties as serving an area of 1 million square kilometers with the children dying at home. Not only can such research happen but it can also uncover important biologic/genetic findings. For example, 2 of the 9 tumors were PNETs instead of gliomas.
It is interesting that the authors concluded with a statement indication for such a program to work there has to be cooperation of the primary neuro-ocnologists with the palliative care team, the pathology department and hospital management. This cooperation is critical in overcoming barriers and logistical issues.



Reference:

J Neurooncol. 2010 May 16
Post mortem Examination in diffuse intrinsic pontine glioma: challenges and chances.
Angelini P, Hawkins, C, Laperriere N, Bouffet E, Bartels U.
Division of Paediatric Haematology and Oncology, The Hospital for Sick Children, Toronto, Canada