Hypofractionated re-irradiation for diffuse intrinsic pontine glioma Journal Article

   


Authors: Mankuzhy, N. P.; Tringale, K. R.; Dunkel, I. J.; Farouk Sait, S.; Souweidane, M. M.; Khakoo, Y.; Karajannis, M. A.; Wolden, S.
Article Title: Hypofractionated re-irradiation for diffuse intrinsic pontine glioma
Abstract: Background: Re-irradiation (reRT) increases survival in locally recurrent diffuse intrinsic pontine glioma (DIPG). There is no standard dose and fractionation for reRT, but conventional fractionation (CF) is typically used. We report our institutional experience of reRT for DIPG, which includes hypofractionation (HF). Methods: We reviewed pediatric patients treated with brainstem reRT for DIPG at our institution from 2012 to 2022. Patients were grouped by HF or CF. Outcomes included steroid use, and overall survival (OS) was measured from both diagnosis and start of reRT. Results: Of 22 patients who received reRT for DIPG, two did not complete their course due to clinical decline. Of the 20 who completed reRT, the dose was 20–30 Gy in 2-Gy fractions (n = 6) and 30–36 Gy in 3-Gy fractions (n = 14). Median age was 5 years (range: 3–14), median interval since initial RT was 8 months (range: 3–20), and 12 received concurrent bevacizumab. Median OS from diagnosis was 18 months [95% confidence interval: 17–24]. Median OS from start of reRT for HF versus CF was 8.2 and 7.5 months, respectively (p =.20). Thirteen (93%) in the HF group and three (75%) in the CF group tapered pre-treatment steroid dose down or off within 2 months after reRT due to clinical improvement. There was no significant difference in steroid taper between HF and CF (p =.4). No patients developed radionecrosis. Conclusion: reRT with HF achieved survival duration comparable to published outcomes and effectively palliated symptoms. Future investigation of this regimen in the context of new systemic therapies and upfront HF is warranted. © 2024 Wiley Periodicals LLC.
Keywords: adolescent; child; clinical article; controlled study; human tissue; overall survival; intensity modulated radiation therapy; bevacizumab; systemic therapy; temozolomide; nuclear magnetic resonance imaging; follow up; dexamethasone; steroid; biopsy; diagnosis; tumor growth; drug therapy; fractionation; brain stem tumor; panobinostat; brain stem; proton radiation; radiation necrosis; brain ventricle peritoneum shunt; re-irradiation; septum pellucidum; diffuse intrinsic pontine glioma; pontine glioma; hypofractionated radiotherapy; human; male; female; article; pediatric patient; omburtamab; special situation for pharmacovigilance; brainstem neoplasms
Journal Title: Pediatric Blood and Cancer
Volume: 71
Issue: 5
ISSN: 1545-5009
Publisher: Wiley Periodicals, Inc  
Date Published: 2024-05-01
Start Page: e30929
Language: English
DOI: 10.1002/pbc.30929
PUBMED: 38430472
PROVIDER: scopus
PMCID: PMC11791744
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85186863106&doi=10.1002%2fpbc.30929&partnerID=40&md5=8c1acd4f215466d1cc2e7fd7b266d7d7
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Nikhil P. Mankuzhy -- Source: Scopus
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MSK Authors
  1. Matthias Angelos Karajannis
    141 Karajannis
  2. Ira J Dunkel
    371 Dunkel
  3. Yasmin Khakoo
    149 Khakoo
  4. Suzanne L Wolden
    560 Wolden
  5. Mark Musa Souweidane
    219 Souweidane
  6. Sameer Farouk Sait
    66 Farouk Sait
  7. Kathryn Ries Tringale
    101 Tringale
  8. Nikhil Pradeep Mankuzhy
    14 Mankuzhy
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