TY - JOUR
T1 - The Role of Hypofractionation Radiotherapy for Diffuse Intrinsic Brainstem Glioma in Children
T2 - A Pilot Study
AU - Janssens, Geert O.R.J.
AU - Gidding, Corrie E.M.
AU - Van Lindert, Erik J.
AU - Oldenburger, Foppe R.
AU - Erasmus, Corrie E.
AU - Schouten-Meeteren, Antoinette Y.N.
AU - Kaanders, Johannes H.A.M.
PY - 2009/3/1
Y1 - 2009/3/1
N2 - 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.
AB - 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.
KW - Brainstem Glioma
KW - Hypofractionation
KW - Radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=59649120555&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2008.05.030
DO - 10.1016/j.ijrobp.2008.05.030
M3 - Article
C2 - 18990510
AN - SCOPUS:59649120555
SN - 0360-3016
VL - 73
SP - 722
EP - 726
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 3
ER -