Diffuse Intrinsic Pontine Glioma (DIPG)

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Diagnosing and Treating DIPG

Unlike some other tumors, a pontine glioma is not usually biopsied. DIPG is usually diagnosed based on the patient’s symptoms and magnetic resonance imaging (MRI) studies.  MRI scans produce detailed images of the brain and allow doctors to detect the presence of a tumor. Sometimes the patient is also given a contrast agent (a special dye) before the scan, so the tumor stands out against normal brain tissue and is easier to view. The location in the pons, the way it infiltrates nearby tissue, and the lack of clear borders of the tumor all signify that a tumor is indeed DIPG.

If the child’s symptoms and the MRI images are not typical, a stereotactic biopsy may be required to make a diagnosis. In this case, a small hole is drilled in the skull and a needle is inserted through the hole to take a small piece of tissue for testing. A pathologist will examine the sample and make a diagnosis.

Treatment for DIPG
Although surgery is the treatment of choice for many other types of brain tumors, it's usually not possible for children with DIPG because the tumor infiltrates extensively into normal brain tissue, making surgical removal impossible. Chemotherapy has not been proven effective, since anti-cancer drugs cannot cross the blood-brain barrier and reach the tumor.

Radiation therapy is the primary treatment for DIPG. Radiation therapy uses X-rays directed at the tumor to help shrink it and reduce pressure on the brain. That can alleviate symptoms quickly, and hold the cancer at bay for several months. Unfortunately, DIPG tends to recur after a few months, and repeated radiation treatments are not well tolerated.

There are a number of clinical trials for DIPG. One potential new treatment now in clinical trial at the Weill Cornell Brain and Spine Center and Memorial Sloan-Kettering involves the delivery of an anti-cancer agent directly to the tumor. Injecting this targeted radio-immunotherapeutic drug directly into the tumor avoids intruding on delicate brain stem tissue and eliminates the need for medicine to cross the blood-brain barrier. Find out more about this clinical trial.

(Find out more about the Children’s Brain Tumor Project.)

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Reviewed by: Zhiping Zhou, Ph.D.
Last reviewed/last updated: November 2014
Illustration by Thom Graves, CMI