Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis
- Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam (Netherlands)
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Radiation Oncology, Erasmus Medical Centre, Rotterdam (Netherlands)
- Department of Radiation Oncology, Academic Medical Centre, Amsterdam (Netherlands)
- Department of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto (Canada)
- Department of Pediatric Oncology, The Royal Marsden NHS Foundation Trust, Sutton (United Kingdom)
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium)
- Department of Pediatric Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Oncology, Great Ormond Street Hospital, London (United Kingdom)
Purpose: Despite conventional radiation therapy, 54 Gy in single doses of 1.8 Gy (54/1.8 Gy) over 6 weeks, most children with diffuse intrinsic pontine glioma (DIPG) will die within 1 year after diagnosis. To reduce patient burden, we investigated the role of hypofractionation radiation therapy given over 3 to 4 weeks. A 1:1 matched-cohort analysis with conventional radiation therapy was performed to assess response and survival. Methods and Materials: Twenty-seven children, aged 3 to 14, were treated according to 1 of 2 hypofractionation regimens over 3 to 4 weeks (39/3 Gy, n=16 or 44.8/2.8 Gy, n=11). All patients had symptoms for {<=}3 months, {>=}2 signs of the neurologic triad (cranial nerve deficit, ataxia, long tract signs), and characteristic features of DIPG on magnetic resonance imaging. Twenty-seven patients fulfilling the same diagnostic criteria and receiving at least 50/1.8 to 2.0 Gy were eligible for the matched-cohort analysis. Results: With hypofractionation radiation therapy, the overall survival at 6, 9, and 12 months was 74%, 44%, and 22%, respectively. Progression-free survival at 3, 6, and 9 months was 77%, 43%, and 12%, respectively. Temporary discontinuation of steroids was observed in 21 of 27 (78%) patients. No significant difference in median overall survival (9.0 vs 9.4 months; P=.84) and time to progression (5.0 vs 7.6 months; P=.24) was observed between hypofractionation vs conventional radiation therapy, respectively. Conclusions: For patients with newly diagnosed DIPG, a hypofractionation regimen, given over 3 to 4 weeks, offers equal overall survival with less treatment burden compared with a conventional regimen of 6 weeks.
- OSTI ID:
- 22149752
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 85, Issue 2; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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