Neurological Symptom Improvement After Re-Irradiation in Patients With Diffuse Intrinsic Pontine Glioma: A Retrospective Analysis of the SIOP-E-HGG/DIPG Project
Por:
Chavaz L, Janssens GO, Bolle S, Mandeville H, Ramos-Albiac M, Van Beek K, Benghiat H, Hoeben B, Morales-La Madrid A, Seidel C, Kortmann RD, Hargrave D, Gandola L, Pecori E, van Vuurden DG, Biassoni V, Massimino M, Kramm CM and von Bueren AO
Publicada:
22 jun 2022
Ahead of Print:
22 jun 2022
Resumen:
PurposeThe aim of this study is to investigate the spectrum of neurological triad improvement in patients with diffuse intrinsic pontine glioma (DIPG) treated by re-irradiation (re-RT) at first progression. MethodsWe carried out a re-analysis of the SIOP-E retrospective DIPG cohort by investigating the clinical benefits after re-RT with a focus on the neurological triad (cranial nerve deficits, ataxia, and long tract signs). Patients were categorized as "responding" or "non-responding" to re-RT. To assess the interdependence between patients' characteristics and clinical benefits, we used a chi-square or Fisher's exact test. Survival according to clinical response to re-RT was calculated by the Kaplan-Meier method. ResultsAs earlier reported, 77% (n = 24/31) of patients had any clinical benefit after re-RT. Among 25/31 well-documented patients, 44% (n = 11/25) had improvement in cranial nerve palsies, 40% (n = 10/25) had improvement in long-tract signs, and 44% (11/25) had improvement in cerebellar signs. Clinical benefits were observed in at least 1, 2, or 3 out of 3 symptoms of the DIPG triad, in 64%, 40%, and 24%, respectively. Patients irradiated with a dose >= 20 Gy versus <20 Gy may improve slightly better with regard to ataxia (67% versus 23%; p-value = 0.028). The survival from the start of re-RT to death was not different between responding and non-responding DIPG patients (p-value = 0.871). ConclusionA median re-irradiation dose of 20 Gy provides a neurological benefit in two-thirds of patients with an improvement of at least one symptom of the triad. DIPG patients receiving >= 20 Gy appear to improve slightly better with regard to ataxia; however, we need more data to determine whether dose escalation up to 30 Gy provides additional benefits.
Filiaciones:
Chavaz L:
Department of Pediatrics, Gynecology and Obstetrics, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
Janssens GO:
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
Bolle S:
Department of Radiation Oncology, Gustave Roussy, Paris Saclay University, Villejuif, France
Mandeville H:
Department of Radiotherapy, The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
Ramos-Albiac M:
Department of Radiation Oncology, Hospital Vall d'Hebron, Barcelona, Spain
Van Beek K:
Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
Benghiat H:
Department of Clinical Oncology, University Hospital Birmingham, Birmingham, United Kingdom
Hoeben B:
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
Morales-La Madrid A:
Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
Seidel C:
Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Germany
Kortmann RD:
Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Germany
Hargrave D:
Pediatric Oncology Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Gandola L:
Pediatric Radiotherapy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
Pecori E:
Pediatric Radiotherapy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
van Vuurden DG:
Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
Biassoni V:
Pediatrics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
Massimino M:
Pediatrics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
Kramm CM:
Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
von Bueren AO:
Department of Pediatrics, Gynecology and Obstetrics, Division of Pediatric Hematology and Oncology, University Hospital of Geneva, Geneva, Switzerland
Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
Green Submitted, Green Accepted, gold
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