Needle-track metastasis in diffuse intrinsic pontine glioma: Need for a standardized surgical strategy?

Nussbaumer G, Nigro O, Barnbrock A, Benesch M, Biassoni V, Bock HC, Carai A, Cavallo A, Chiesa S, Giandini T, Colafati GS, De Martino L, Demmert M, di Ruscio V, Franke JM, Friker LL, Gielen GH, Hoffmann M, Jablonska K, Karow A, Karremann M, Kerl K, Knerlich-Lukoschus F, Kramm CM, Krause M, Makocki S, Mastronuzzi A, Massimino M, Morales La Madrid A, Pecori E, Perwein T, Pietsch T, Rades D, Rödel C, Santa-Maria Lopez V, Schiavello E, Schwarz R, Scobioala S, Simon T, Spille DC, Thomale UW, Trovò A, Vennarini S, von Bueren AO, Bison B, Valentini C (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 8

Article Number: vdag155

Journal Issue: 1

DOI: 10.1093/noajnl/vdag155

Abstract

Background: Diffuse intrinsic pontine glioma (DIPG) remains uniformly lethal. Stereotactic biopsy confirms the diagnosis and enables molecular profiling. Metastasis along the biopsy track (BTM) has been reported only anecdotally; its prevalence, clinical relevance, and implications for treatment remain unclear. Methods: A multicenter retrospective study in patients with confirmed DIPG and BTM was conducted based on central neuroradiologic review. Radiotherapy schedules were re-assessed to evaluate the feasibility of upfront biopsy track irradiation. Results: Ten children met inclusion criteria (median age 6.8 years). Biopsy route was supratentorial in six and infratentorial in four children, and side-cutting needles were used predominantly. H3F3A mutations were most frequent (n = 8); TP53 alterations were common in tumors with extended molecular profiling available. Median PFS was 8.1 months. Five patients each developed BTM prior to (median 2.7 months) or concurrently with progression of primary tumor. There was no difference in overall survival (median OS 12.0 months) compared with the reference cohort. Estimated BTM prevalence among biopsied DIPG from additional registry data was between 6.9% and 13.0%. Primary biopsy track irradiation proved to be feasible, and comparing the surgical access routes, the infratentorial biopsy track hardly increased radiation exposure of the whole brain. Conclusions: Needle track metastasis is a rare progression pattern in stereotactic biopsied DIPG. Upfront irradiation of the biopsy track may represent a strategy to mitigate the potential risk of BTM. From a dosimetric perspective, an infratentorial approach may therefore be considered, as it was associated with only marginally increased radiation exposure.

Authors with CRIS profile

Involved external institutions

Medizinische Universität Graz Austria (AT) Fondazione IRCCS: Istituto Nazionale dei Tumori Italy (IT) Universitätsklinikum Göttingen Germany (DE) Ospedale Pediatrico Bambino Gesu Italy (IT) Fondazione Policlinico Universitario Agostino Gemelli IRCCS Italy (IT) Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon Italy (IT) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universitätsklinikum Bonn Germany (DE) Universitätsklinikum Köln Germany (DE) Universitätsklinikum Mannheim / University Medical Centre Mannheim (Universitätsmedizin Mannheim) Germany (DE) Universitätsklinikum Münster Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Hospital Sant Joan de Déu Barcelona Spain (ES) Universität zu Lübeck Germany (DE) Goethe-Universität Frankfurt am Main Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universität zu Köln Germany (DE) Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG) Switzerland (CH) Universität Augsburg Germany (DE)

How to cite

APA:

Nussbaumer, G., Nigro, O., Barnbrock, A., Benesch, M., Biassoni, V., Bock, H.C.,... Valentini, C. (2026). Needle-track metastasis in diffuse intrinsic pontine glioma: Need for a standardized surgical strategy? Neuro-Oncology Advances, 8(1). https://doi.org/10.1093/noajnl/vdag155

MLA:

Nussbaumer, Gunther, et al. "Needle-track metastasis in diffuse intrinsic pontine glioma: Need for a standardized surgical strategy?" Neuro-Oncology Advances 8.1 (2026).

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