AUTHOR=Colafati Giovanna Stefania , Voicu Ioan Paul , Carducci Chiara , Caulo Massimo , Vinci Maria , Diomedi-Camassei Francesca , Merli Pietro , Carai Andrea , Miele Evelina , Cacchione Antonella , Tomà Paolo , Locatelli Franco , Mastronuzzi Angela 

TITLE=Direct Involvement of Cranial Nerve V at Diagnosis in Patients With Diffuse Intrinsic Pontine Glioma: A Potential Magnetic Resonance Predictor of Short-Term Survival

JOURNAL=Frontiers in Oncology

VOLUME=Volume 9 - 2019

YEAR=2019

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2019.00204

DOI=10.3389/fonc.2019.00204

ISSN=2234-943X

ABSTRACT=Background 
 Diffuse intrinsic pontine glioma (DIPG) has a dismal prognosis. Magnetic resonance imaging 
 (MRI) remains the gold standard for non-invasive DIPG diagnosis. MRI features have been tested 
 as surrogate biomarkers. We investigated the direct involvement of cranial nerve V (CN V) in DIPG 
 at diagnosis and its utility as predictor of poor overall survival. 
 Materials and methods 
 We examined MRI scans of 35 consecutive patients with radiological diagnosis of DIPG. Clinical 
 and radiological data of the patients were collected separately. Direct involvement of CN V was 
 assessed on the diagnostic scans. Patients with an overall survival of less than 24 months were 
 analysed. Overall survival (OS) and time to progression (TTP) were evaluated. Analyzed features 
 were involvement of CN V, sex, age, tumor size, ring enhancement and therapy used as first line of 
 treatment. Correlations between involvement of CN V with disease dissemination and with magnet 
 strength were analyzed. Statistical analysis included Kaplan-Meier curves, log-rank test and 
 Spearman’s Rho. 
 Results 
 Of the 35 patients in our initial cohort, 6 long-term survivors were excluded from survival analysis. 
 Therefore, 29 patients were examined (15 M, 14 F). Four patients in this group presented direct 
 involvement of CN V. Histological data were available in twelve patients. Median OS was 11 
 months (range 3-23 months). Significant differences in OS were found in direct involvement of CN 
 V (7 months, 95% CI 1.1-12.9 months for involvement of CN V versus 13 months, 95% CI 10.2-
 15.7 for lack of involvement of CN V respectively, p<0.049). Significant differences in TTP were 
 found for treatment (4 months, 95% CI 2.6-5.3 months versus 7 months, 95% CI 5.9-8.1 
 respectively, p<0.027). The other factors did not significantly affect OS (p=NS) and TTP (p=NS),
 respectively. No significant correlation was found between involvement of CN V and magnet 
 strength or slice thickness (r=-0.201; p=NS). 
 A trend towards positive correlation was found between direct involvement of CN V at diagnosis 31
 and dissemination of disease at follow-up (r=0.347; p<0.065), 
 In conclusion, in our cohort direct involvement of CN V correlated with poor prognosis. Based on 34
 our data, we suggest