I confess I have never surfed. Still, I imagine that DIPG research could be compared to surfers paddling out on the ocean waiting for a wave. For DIPG though, the waters have been incredibly flat for a long time. Now, the sea is changing.
For years, we have been stuck in a conundrum. We need tissue to know if a child can get benefit from a therapy but maybe we should not biopsy unless we know that the child will get benefit. It has been a catch-22 that has been difficult to break.
As the era of tumor molecular biology has blossomed, France first re-instituted the biopsy option for typically appearing pediatric diffuse intrinsic pontine glioma. Increasingly there have been ripples all over the world expressing the importance of biopsies in designing treatment for these children in hopes of finally improving the dismal statistics.
Last year, Ryo Nishikawa, a Japanese neurosurgeon and Executive Editor JSNO, wrote a short opinion letter in Neuro-Oncology. Despite the issue of intratumoral variation, he pointed out that biospies must be performed to "determine genetic profiles" of brainstem lesions. He also highlights the neurosurgical advances in stereotactic biopsy which has made it more feasible and less dangerous to biopsy brainstem lesions. He concluded with the statement raising hopes for tailored treatment in pediatric DIPG.
As I read more articles on the DIPG biopsy issues, I also have the feeling of new waves for diffuse intrinsic pontine glioma research and treatment.
Reference:
Diffuse intrinsic pontine gliomas: New Waves
Neuro Oncol. 2012 March; 14(3): 245.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280815/
