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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.

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Date
2017-03
ICR Author
Mandeville, Henry
Marsden,
Author
Janssens, GO
Gandola, L
Bolle, S
Mandeville, H
Ramos-Albiac, M
van Beek, K
Benghiat, H
Hoeben, B
Morales La Madrid, A
Kortmann, R-D
Hargrave, D
Menten, J
Pecori, E
Biassoni, V
von Bueren, AO
van Vuurden, DG
Massimino, M
Sturm, D
Peters, M
Kramm, CM
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Type
Journal Article
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Abstract
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.
URI
https://repository.icr.ac.uk/handle/internal/1130
DOI
https://doi.org/10.1016/j.ejca.2016.12.007
Collections
  • Radiotherapy and Imaging
Subject
Humans
Glioma
Brain Stem Neoplasms
Disease Progression
Magnetic Resonance Imaging
Prognosis
Multivariate Analysis
Survival Analysis
Retrospective Studies
Adolescent
Child
Child, Preschool
Female
Male
Re-Irradiation
Research team
Paediatric and Adolescent Radiotherapy
Language
eng
Date accepted
2016-12-05
License start date
2017-03
Citation
European journal of cancer (Oxford, England : 1990), 2017, 73 pp. 38 - 47

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