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

Abstract

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 (9.0more » 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.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [10];  [1]; ;  [2];  [11];  [12]
  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)
Publication Date:
OSTI Identifier:
22149752
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 85; Journal 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); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHILDREN; DIAGNOSIS; GLIOMAS; NMR IMAGING; PATIENTS; RADIATION DOSES; RADIOTHERAPY; STEROIDS; SYMPTOMS

Citation Formats

Janssens, Geert O., E-mail: g.janssens@rther.umcn.nl, Jansen, Marc H., Lauwers, Selmer J., Nowak, Peter J., Oldenburger, Foppe R., Bouffet, Eric, Saran, Frank, Kamphuis-van Ulzen, Karin, Lindert, Erik J. van, Schieving, Jolanda H., Boterberg, Tom, Kaspers, Gertjan J., Span, Paul N., Kaanders, Johannes H., Gidding, Corrie E., and Hargrave, Darren. Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis. United States: N. p., 2013. Web. doi:10.1016/J.IJROBP.2012.04.006.
Janssens, Geert O., E-mail: g.janssens@rther.umcn.nl, Jansen, Marc H., Lauwers, Selmer J., Nowak, Peter J., Oldenburger, Foppe R., Bouffet, Eric, Saran, Frank, Kamphuis-van Ulzen, Karin, Lindert, Erik J. van, Schieving, Jolanda H., Boterberg, Tom, Kaspers, Gertjan J., Span, Paul N., Kaanders, Johannes H., Gidding, Corrie E., & Hargrave, Darren. Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis. United States. https://doi.org/10.1016/J.IJROBP.2012.04.006
Janssens, Geert O., E-mail: g.janssens@rther.umcn.nl, Jansen, Marc H., Lauwers, Selmer J., Nowak, Peter J., Oldenburger, Foppe R., Bouffet, Eric, Saran, Frank, Kamphuis-van Ulzen, Karin, Lindert, Erik J. van, Schieving, Jolanda H., Boterberg, Tom, Kaspers, Gertjan J., Span, Paul N., Kaanders, Johannes H., Gidding, Corrie E., and Hargrave, Darren. 2013. "Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis". United States. https://doi.org/10.1016/J.IJROBP.2012.04.006.
@article{osti_22149752,
title = {Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis},
author = {Janssens, Geert O., E-mail: g.janssens@rther.umcn.nl and Jansen, Marc H. and Lauwers, Selmer J. and Nowak, Peter J. and Oldenburger, Foppe R. and Bouffet, Eric and Saran, Frank and Kamphuis-van Ulzen, Karin and Lindert, Erik J. van and Schieving, Jolanda H. and Boterberg, Tom and Kaspers, Gertjan J. and Span, Paul N. and Kaanders, Johannes H. and Gidding, Corrie E. and Hargrave, Darren},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2012.04.006},
url = {https://www.osti.gov/biblio/22149752}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 85,
place = {United States},
year = {Fri Feb 01 00:00:00 EST 2013},
month = {Fri Feb 01 00:00:00 EST 2013}
}