26 Jul 2024

We refer to the article “S’pore baby with 1 in 100 million brain stem tumour survives and thrives against all odds” (June 22).

 

This article has been reported as a medical mystery with postulations on possible treatment-related contributions leading to the current clinical status of Baby E where her tumour has shrunk and appears to have stopped progressing.

 

It is heart-warming that Baby E has continued to survive against the odds despite being diagnosed with a high-grade glioma in the brainstem which is a malignant tumour known to have a median survival of less than one year.

 

There have only been a few case reports in published literature that have demonstrated spontaneous regression of brainstem lesions occurring particularly in very young infants. In these reports, some patients were found to have MRI features suggestive of high-grade diffuse brainstem gliomas but did not undergo a surgical biopsy. These reports suggest that such paediatric patients fall under a specific sub-category of diffuse brainstem lesions which may have a better prognosis.

 

The current standard of care for most adult and paediatric brain tumours is well established. Histopathological diagnosis of a lesion is paramount in providing the needed information to guide appropriate treatment. This may be performed via a needle biopsy or open surgery to obtain a sample of the tumour cells.

 

It is important to highlight that the procedure itself is meant to be diagnostic and does not serve any therapeutic role. Surgical procedures involving the brainstem or other critical locations in the brain put each patient at risk of serious and life-threatening consequences and as such require discussions with the care team to evaluate the risk-benefits and appropriate timing of surgery.

 

There is currently no evidence that a needle or open surgery for a biopsy is associated with a higher chance of cure or results in tumour regression. Histopathological findings obtained from a biopsy guide further treatment which may involve radiotherapy, chemotherapy or possible targeted drug therapies based on specific molecular findings unique to each individual’s tumour.

 

This approach is the gold standard practised in both local and international public and private healthcare institutions where multi-disciplinary teams comprising surgeons, oncologists, pathologists and radiation oncologists play a collective role.

 

David Low (Associate Professor)
Chairman
Chapter of Neurosurgeons
College of Surgeons, Singapore
Academy of Medicine, Singapore

 

This letter can be viewed on The Straits Times Forum.