The Role of Hypofractionation Radiotherapy for Diffuse Intrinsic Brainstem Glioma in Children: A Pilot Study
- Department of Pediatric Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Radiation Oncology, Academic Medical Center Amsterdam, Amsterdam (Netherlands)
- Department of Pediatric Neurology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)
- Department of Pediatric Oncology, Academic Medical Center Amsterdam, Amsterdam (Netherlands)
Purpose: Most children with a diffuse intrinsic brainstem glioma will die within 1 year after diagnosis. To reduce patient burden, we investigated the feasibility of a radical hypofractionation radiotherapy schedule, given over 3 weeks, as an alternative to the standard regimen (30 fractions over 6 weeks). Methods and Materials: Nine children, ages 3-13, were treated by 13 fractions of 3 Gy (n = 8) or 6 fractions of 5.5 Gy (n = 1) given over 3 weeks. All patients had symptoms for {<=}3 months and {>=}2 signs of the neurologic triad (long tract signs, ataxia, cranial nerve deficit). Bilateral involvement of the pons (n = 8), encasement of the basilar artery (n = 7) and extension into the cerebellar peduncle (n = 6) was visible on magnetic resonance imaging. Results: Symptom improvement occurred in all patients within 2 weeks after start of radiotherapy. At a mean follow-up time of 15 months, 7 patients have died. Median time to progression and overall survival was 4.9 and 8.6 months, respectively. Median time to death after progression was 3.6 months. No Grade 3 or 4 toxicity was observed. In a recently published review of clinical trials, median time to progression, overall survival, and time between progression and death ranged from 5.0-8.8, 7.0-16, and 1.0-4.5 months, respectively, with more aggressive regimens. Conclusion: This radical hypofractionation radiotherapy regimen for children with diffuse intrinsic brainstem glioma is feasible and associated with no Grade 3 or 4 toxicities. With a minimal overall treatment time, it offers quick symptom relief and outcome results within the range of published data.
- OSTI ID:
- 21172621
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 73, Issue 3; Other Information: DOI: 10.1016/j.ijrobp.2008.05.030; PII: S0360-3016(08)00932-2; Copyright (c) 2009 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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