Journal article
Survival benefit for patients with diffuse intrinsic pontine glioma (DIPG) undergoing re-irradiation at first progression: A matched-cohort analysis on behalf of the SIOP-E-HGG/DIPG working group.
- Janssens GO Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands. Electronic address: g.o.r.janssens@umcutrecht.nl.
- Gandola L Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
- Bolle S Department of Radiotherapy, Gustave Roussy Cancer Campus, Villejuif Cedex, France.
- Mandeville H Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK.
- Ramos-Albiac M Department of Radiation Oncology, Hospital Vall d'Hebron, Barcelona, Spain.
- van Beek K Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
- Benghiat H Department of Clinical Oncology, University Hospital Birmingham, Birmingham, UK.
- Hoeben B Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Morales La Madrid A Department of Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain.
- Kortmann RD Department of Radiation Therapy, University Hospital Leipzig, Leipzig, Germany.
- Hargrave D Pediatric Oncology Unit, Great Ormond Street Hospital, London, UK.
- Menten J Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
- Pecori E Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
- Biassoni V Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
- von Bueren AO Department of Hematology & Oncology, University of Geneva, Geneva, Switzerland; Department of Pediatric Hematology & Oncology, University Hospital Goettingen, Goettingen, Germany.
- van Vuurden DG Department of Pediatric Oncology & Hematology, VU University Medical Center, Amsterdam, The Netherlands.
- Massimino M Pediatrics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
- Sturm D Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Peters M Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Kramm CM Department of Pediatric Hematology & Oncology, University Hospital Goettingen, Goettingen, Germany.
- 2017-02-06
Published in:
- European journal of cancer (Oxford, England : 1990). - 2017
Diffuse intrinsic pontine glioma (DIPG)
Matched-cohort analysis
Radiotherapy
Re-irradiation
Survival prediction model
Adolescent
Brain Stem Neoplasms
Child
Child, Preschool
Disease Progression
Female
Glioma
Humans
Magnetic Resonance Imaging
Male
Multivariate Analysis
Prognosis
Re-Irradiation
Retrospective Studies
Survival Analysis
English
BACKGROUND
Overall survival (OS) of patients with diffuse intrinsic pontine glioma (DIPG) is poor. The purpose of this study is to analyse benefit and toxicity of re-irradiation at first progression.
METHODS
At first progression, 31 children with DIPG, aged 2-16 years, underwent re-irradiation (dose 19.8-30.0 Gy) alone (n = 16) or combined with systemic therapy (n = 15). At initial presentation, all patients had typical symptoms and characteristic MRI features of DIPG, or biopsy-proven high-grade glioma. An interval of ≥3 months after upfront radiotherapy was required before re-irradiation. Thirty-nine patients fulfilling the same criteria receiving radiotherapy at diagnosis, followed by best supportive care (n = 20) or systemic therapy (n = 19) at progression but no re-irradiation, were eligible for a matched-cohort analysis.
RESULTS
Median OS for patients undergoing re-irradiation was 13.7 months. For a similar median progression-free survival after upfront radiotherapy (8.2 versus 7.7 months; P = .58), a significant benefit in median OS (13.7 versus 10.3 months; P = .04) was observed in favour of patients undergoing re-irradiation. Survival benefit of re-irradiation increased with a longer interval between end-of-radiotherapy and first progression (3-6 months: 4.0 versus 2.7; P < .01; 6-12 months: 6.4 versus 3.3; P = .04). Clinical improvement with re-irradiation was observed in 24/31 (77%) patients. No grade 4-5 toxicity was recorded. On multivariable analysis, interval to progression (corrected hazard ratio = .27-.54; P < .01) and re-irradiation (corrected hazard ratio = .18-.22; P < .01) remained prognostic for survival. A risk score (RS), comprising 5 categories, was developed to predict survival from first progression (ROC: .79). Median survival ranges from 1.0 month (RS-1) to 6.7 months (RS-5).
CONCLUSIONS
The majority of patients with DIPG, responding to upfront radiotherapy, do benefit of re-irradiation with acceptable tolerability.
Overall survival (OS) of patients with diffuse intrinsic pontine glioma (DIPG) is poor. The purpose of this study is to analyse benefit and toxicity of re-irradiation at first progression.
METHODS
At first progression, 31 children with DIPG, aged 2-16 years, underwent re-irradiation (dose 19.8-30.0 Gy) alone (n = 16) or combined with systemic therapy (n = 15). At initial presentation, all patients had typical symptoms and characteristic MRI features of DIPG, or biopsy-proven high-grade glioma. An interval of ≥3 months after upfront radiotherapy was required before re-irradiation. Thirty-nine patients fulfilling the same criteria receiving radiotherapy at diagnosis, followed by best supportive care (n = 20) or systemic therapy (n = 19) at progression but no re-irradiation, were eligible for a matched-cohort analysis.
RESULTS
Median OS for patients undergoing re-irradiation was 13.7 months. For a similar median progression-free survival after upfront radiotherapy (8.2 versus 7.7 months; P = .58), a significant benefit in median OS (13.7 versus 10.3 months; P = .04) was observed in favour of patients undergoing re-irradiation. Survival benefit of re-irradiation increased with a longer interval between end-of-radiotherapy and first progression (3-6 months: 4.0 versus 2.7; P < .01; 6-12 months: 6.4 versus 3.3; P = .04). Clinical improvement with re-irradiation was observed in 24/31 (77%) patients. No grade 4-5 toxicity was recorded. On multivariable analysis, interval to progression (corrected hazard ratio = .27-.54; P < .01) and re-irradiation (corrected hazard ratio = .18-.22; P < .01) remained prognostic for survival. A risk score (RS), comprising 5 categories, was developed to predict survival from first progression (ROC: .79). Median survival ranges from 1.0 month (RS-1) to 6.7 months (RS-5).
CONCLUSIONS
The majority of patients with DIPG, responding to upfront radiotherapy, do benefit of re-irradiation with acceptable tolerability.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ejca.2016.12.007
- PMID 28161497
- Persistent URL
- https://folia.unifr.ch/global/documents/103492
Statistics
Document views: 18
File downloads: