OBJECTIVE: Clinical trials have failed to demonstrate a survival benefit of adjuvant chemotherapy in diffuse intrinsic pontine gliomas (DIPG). Radiation therapy (RT) is the only effective treatment thus far and reirradiation (rRT) has become an option at the time of progression. The aim of this study was to review the Canadian experience of DIPG rRT with a focus on the safety and possible efficacy of this approach. METHOD: We retrospectively reviewed the demographic, clinical, and RT data of patients with DIPG treated in Canada with rRT. RESULTS: Since January 2011, we identified 16 patients with progressive DIPG who received rRT. Median time from diagnosis to progression was 10.5 months (range, 4-37 months). rRT was given focally in 14 patients at a dose ranging from 21.6 to 36 Gy. rRT was well tolerated by all children but one. All but three patients showed neurological improvement. With a median follow-up from original diagnosis of 19.2 months, all patients died, with a median time from rRT to death of 6.48 months (range, 3.83-13.26 months). When compared to a historic cohort of 46 consecutive patients, the median time from progression to death was 92 days in the non-reirradiated patients versus 218 days in the reirradiated ones (P = 0.0001). CONCLUSION: In this limited experience, rRT was safe and feasible in patients with progressive DIPG, providing neurological improvement and a prolonged life span in most patients. Prospective Canadian rRT protocols are ongoing to further assess the benefit of this approach, including quality of life assessment.
OBJECTIVE: Clinical trials have failed to demonstrate a survival benefit of adjuvant chemotherapy in diffuse intrinsic pontine gliomas (DIPG). Radiation therapy (RT) is the only effective treatment thus far and reirradiation (rRT) has become an option at the time of progression. The aim of this study was to review the Canadian experience of DIPG rRT with a focus on the safety and possible efficacy of this approach. METHOD: We retrospectively reviewed the demographic, clinical, and RT data of patients with DIPG treated in Canada with rRT. RESULTS: Since January 2011, we identified 16 patients with progressive DIPG who received rRT. Median time from diagnosis to progression was 10.5 months (range, 4-37 months). rRT was given focally in 14 patients at a dose ranging from 21.6 to 36 Gy. rRT was well tolerated by all children but one. All but three patients showed neurological improvement. With a median follow-up from original diagnosis of 19.2 months, all patients died, with a median time from rRT to death of 6.48 months (range, 3.83-13.26 months). When compared to a historic cohort of 46 consecutive patients, the median time from progression to death was 92 days in the non-reirradiated patients versus 218 days in the reirradiated ones (P = 0.0001). CONCLUSION: In this limited experience, rRT was safe and feasible in patients with progressive DIPG, providing neurological improvement and a prolonged life span in most patients. Prospective Canadian rRT protocols are ongoing to further assess the benefit of this approach, including quality of life assessment.
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: Chloé Louise Gelder; Cynthia Hawkins; Michal Zapotocky; Peter Dirks; Ute Bartels; Eric Bouffet Journal: Childs Nerv Syst Date: 2019-01-31 Impact factor: 1.475
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
Authors: Chul Kee Park; Youn Soo Lee; Ho Shin Gwak; Hong In Yoon; Chan Woo Wee; Young Zoon Kim; Youngbeom Seo; Jung Ho Im; Yun Sik Dho; Kyung Hwan Kim; Je Beom Hong; Jae Sung Park; Seo Hee Choi; Min Sung Kim; Jangsup Moon; Kihwan Hwang; Ji Eun Park; Jin Mo Cho; Wan Soo Yoon; Se Hoon Kim; Young Il Kim; Ho Sung Kim; Kyoung Su Sung; Jin Ho Song; Min Ho Lee; Myung Hoon Han; Se Hoon Lee; Jong Hee Chang; Do Hoon Lim Journal: Brain Tumor Res Treat Date: 2021-04