What treatment would you offer a young pregnant woman with a symptomatic midline low grade glioma?

The question is really in the biology of this midline low grade glioma, in particular K27M status and BRAF status, amongst others. It is very challenging to answer without a clear idea of the tumor and ongoing symptoms. It would also be important to have a look at the MRI scan.

Eric Bouffet

eric.bouffet@sickkids.ca

There is no easy answer to this question. There are many things to consider—mutation/molecular status, symptoms, any concerning changes seen on imaging, how far along the patient is in pregnancy (is it safe to deliver child? or would there be risk of complications from prematurity?), symptoms patient is having (seizures in particular, as this would be a risk to both mother and fetus) and previous treatment. Obviously systemic therapy and radiation should be avoided during pregnancy.

Ideally, if ...