Christopher Freese1, Vinita Takiar1, Maryam Fouladi2, Mariko DeWire2, John Breneman1, Luke Pater3. 1. Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, Cincinnati, Ohio. 2. Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 3. Department of Radiation Oncology, University of Cincinnati Barrett Cancer Center, Cincinnati, Ohio. Electronic address: paterl@ucmail.uc.edu.
Abstract
PURPOSE: Diffuse intrinsic pontine glioma (DIPG) is a devastating pediatric disease, with a median survival of <1 year. Here, we review our institution's DIPG experience over an 8-year interval and perform a systematic review of the literature, specifically evaluating reports of reirradiation (reRT) for DIPG. METHODS AND MATERIALS: We retrospectively reviewed the medical records of 26 patients who underwent definitive intensity modulated radiation therapy (IMRT) for DIPG at a single institution between 2007 and 2015. Three of these patients underwent reRT for progressive disease. Clinical endpoints, including progression-free survival and overall survival (OS), were assessed. We then performed a thorough PubMed search of the literature discussing reRT for patients with DIPG. RESULTS: Twenty-four of the 26 patients (92%) completed the initial course of radiation (54 Gy in 1.8-Gy fractions using IMRT). Median age at diagnosis was 6.0 years (range, 2.0-26.5). With respect to systemic therapy, 1 (4.2%) received no systemic therapy, 1 (4.2%) received concurrent systemic therapy alone, 4 (16.7%) received adjuvant therapy alone, and 18 (75%) received a combination of concurrent and adjuvant therapy. Median follow-up time was 11 months from the date of initial diagnosis. Median OS for the cohort was 12 months, with a 1-year OS of 51%. The 3 patients who underwent reRT received 20 Gy in 10 daily fractions using IMRT alone with no treatment toxicity noted. CONCLUSIONS: Radiation therapy is essential in the definitive management of DIPG. With advances in treatment techniques, it is feasible to reirradiate select patients with progressive disease; however, further research is warranted to optimize dose, delivery, and patient selection in the recurrent/progressive setting. In the future, it may be reasonable to propose more focal delivery of reRT (ie, hypofractionated radiation) in select patients with the goal of reducing treatment time and providing effective palliation.
PURPOSE: Diffuse intrinsic pontine glioma (DIPG) is a devastating pediatric disease, with a median survival of <1 year. Here, we review our institution's DIPG experience over an 8-year interval and perform a systematic review of the literature, specifically evaluating reports of reirradiation (reRT) for DIPG. METHODS AND MATERIALS: We retrospectively reviewed the medical records of 26 patients who underwent definitive intensity modulated radiation therapy (IMRT) for DIPG at a single institution between 2007 and 2015. Three of these patients underwent reRT for progressive disease. Clinical endpoints, including progression-free survival and overall survival (OS), were assessed. We then performed a thorough PubMed search of the literature discussing reRT for patients with DIPG. RESULTS: Twenty-four of the 26 patients (92%) completed the initial course of radiation (54 Gy in 1.8-Gy fractions using IMRT). Median age at diagnosis was 6.0 years (range, 2.0-26.5). With respect to systemic therapy, 1 (4.2%) received no systemic therapy, 1 (4.2%) received concurrent systemic therapy alone, 4 (16.7%) received adjuvant therapy alone, and 18 (75%) received a combination of concurrent and adjuvant therapy. Median follow-up time was 11 months from the date of initial diagnosis. Median OS for the cohort was 12 months, with a 1-year OS of 51%. The 3 patients who underwent reRT received 20 Gy in 10 daily fractions using IMRT alone with no treatment toxicity noted. CONCLUSIONS:Radiation therapy is essential in the definitive management of DIPG. With advances in treatment techniques, it is feasible to reirradiate select patients with progressive disease; however, further research is warranted to optimize dose, delivery, and patient selection in the recurrent/progressive setting. In the future, it may be reasonable to propose more focal delivery of reRT (ie, hypofractionated radiation) in select patients with the goal of reducing treatment time and providing effective palliation.
Authors: Lara Chavaz; Geert O Janssens; Stephanie Bolle; Henry Mandeville; Monica Ramos-Albiac; Karen Van Beek; Helen Benghiat; Bianca Hoeben; Andres Morales La Madrid; Clemens Seidel; Rolf-Dieter Kortmann; Darren Hargrave; Lorenza Gandola; Emilia Pecori; Dannis G van Vuurden; Veronica Biassoni; Maura Massimino; Christof M Kramm; Andre O von Bueren Journal: Front Oncol Date: 2022-06-22 Impact factor: 5.738
Authors: Eden G Robertson; Claire E Wakefield; Maria Tsoli; Stewart J Kellie; Frank Alvaro; Andrew J Gifford; Martin A Weber; Michael Rodriguez; Maria Kirby; David S Ziegler Journal: Neurooncol Adv Date: 2021-08-25
Authors: Dries Ruttens; Julie Messiaen; Alina Ferster; Caroline Piette; Stefan Schifflers; An Van Damme; Jutte van der Werff Ten Bosch; Joris Verlooy; Leen Willems; Sandra Jacobs Journal: J Neurooncol Date: 2021-05-03 Impact factor: 4.130
Authors: Michael I Chastkofsky; Katarzyna C Pituch; Hiroaki Katagi; Markella Zannikou; Liliana Ilut; Ting Xiao; Yu Han; Adam M Sonabend; David T Curiel; Erin R Bonner; Javad Nazarian; Craig M Horbinski; C David James; Amanda M Saratsis; Rintaro Hashizume; Maciej S Lesniak; Irina V Balyasnikova Journal: Clin Cancer Res Date: 2020-12-03 Impact factor: 13.801
Authors: Matthew Gallitto; Stanislav Lazarev; Isaac Wasserman; James M Stafford; Suzanne L Wolden; Stephanie A Terezakis; Ranjit S Bindra; Richard L Bakst Journal: Adv Radiat Oncol Date: 2019-03-30