NF1 optic pathway glioma: analyzing risk factors for visual outcome and indications to treat. Issue 1 (6th July 2020)

• Record Type: Journal Article
• Authors: Azizi, Amedeo A; Walker, David A; Liu, Jo-Fen; Sehested, Astrid; Jaspan, Timothy; Pemp, Berthold; Simmons, Ian; Ferner, Rosalie; Grill, Jacques; Hargrave, Darren; Driever, Pablo Hernáiz; Evans, D Gareth; Opocher, Enrico
• Is Part Of: Neuro-oncology. Volume 23:Issue 1(2021)
• Page Start: 100
• Page End: 111
• Publication Date: 2020-07-06
• Subjects: neurofibromatosis 1 -- optic pathway glioma -- treatment -- vision -- visual outcome; Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noaa153
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: Background: The aim of the project was to identify risk factors associated with visual progression and treatment indications in pediatric patients with neurofibromatosis type 1 associated optic pathway glioma (NF1-OPG). Methods: A multidisciplinary expert group consisting of ophthalmologists, pediatric neuro-oncologists, neurofibromatosis specialists, and neuro-radiologists involved in therapy trials assembled a cohort of children with NF1-OPG from 6 European countries with complete clinical, imaging, and visual outcome datasets. Using methods developed during a consensus workshop, visual and imaging data were reviewed by the expert team and analyzed to identify associations between factors at diagnosis with visual and imaging outcomes. Results: Eighty-three patients (37 males, 46 females, mean age 5.1 ± 2.6 y; 1–13.1 y) registered in the European treatment trial SIOP LGG-2004 (recruited 2004–2012) were included. They were either observed or treated (at diagnosis/after follow-up). In multivariable analysis, factors present at diagnosis associated with adverse visual outcomes included: multiple visual signs and symptoms (adjusted odds ratio [adjOR]: 8.33; 95% CI: 1.9–36.45), abnormal visual behavior (adjOR: 4.15; 95% CI: 1.20–14.34), new onset of visual symptoms (adjOR: 4.04; 95% CI: 1.26–12.95), and optic atrophy (adjOR: 3.73; 95% CI: 1.13–12.53). Squint, posterior visual pathway tumor involvement, and bilateral pathway tumor involvement showed borderline significance. Treatment appeared to reduce tumor size but improved vision in only 10/45 treated patients. Children with visual deterioration after primary observation are more likely to improve with treatment than children treated at diagnosis. Conclusions: The analysis identified the importance of symptomatology, optic atrophy, and history of vision loss as predictive factors for poor visual outcomes in children with NF1-OPG.