Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis

Journal Article · Thu Jan 31 23:00:00 EST 2013 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2012.04.006· OSTI ID:22149752

Jansen, Marc H. ^[1]; Lauwers, Selmer J. ^[2]; Nowak, Peter J. ^[3]; Oldenburger, Foppe R. ^[4]; Bouffet, Eric ^[5]; Saran, Frank ^[6]; Kamphuis-van Ulzen, Karin ^[7]; Lindert, Erik J. van ^[8]; Schieving, Jolanda H. ^[9]; Boterberg, Tom ^[10]; Kaspers, Gertjan J. ^[1]; Span, Paul N.; Kaanders, Johannes H. ^[2]; Gidding, Corrie E. ^[11]; Hargrave, Darren ^[12]

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1. Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam (Netherlands)
2. Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
3. Department of Radiation Oncology, Erasmus Medical Centre, Rotterdam (Netherlands)
4. Department of Radiation Oncology, Academic Medical Centre, Amsterdam (Netherlands)
5. Department of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto (Canada)
6. Department of Pediatric Oncology, The Royal Marsden NHS Foundation Trust, Sutton (United Kingdom)
7. Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
8. Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
9. Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
10. Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium)
11. Department of Pediatric Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
12. 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, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 85; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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