Hyperfractionated radiation therapy (72 Gy) for children with brain stem gliomas A childrens cancer group phase I/II trial

Abstract

Background. Most children with brain stem gliomas (BSG) die within 18 months of diagnosis. Early experience suggested that hyperfractionated radiation therapy (RT) at a dose of 72 Gy, administered in 1‐Gy fractions twice daily, possibly improved disease‐free survival for children with BSG. Methods. To better characterize the toxicity and possible efficacy of this dose and fractionation of RT, 53 assessable children with diffuse intrinsic or malignant BSG were treated. Survival figures also were combined with outcome in 36 patients treated in a previous pilot study. Results. An objective response to treatment was observed in 28 of 53 (53%) patients; a partial response occurred in 7. No child died of treatment‐related brain necrosis, although 7 of 53 did have intralesional cystic/necrotic changes within 6 weeks of completion of RT. The overall survival rate for patients in the study was 38% (± 6.5) at 1 year, 14% (± 5.4) at 2 years, and 8% (± 6.5) at 3 years. Leptomeningeal dissemination was observed in 4 of 48 (8%) children who had relapses. A greater than 2‐month duration of symptoms before diagnosis was related to a better prognosis. There was no statistical association between any other clinical parameter, neuroradiographic finding, or pathologic finding and outcome. Combined with that in 35 patients treated in the pilot study, the survival rate in 88 children was 14% (k 5) at 3 years. Conclusions. The radiographic response rate is encouraging; however, it cannot be concluded that hyperfractionated RT, at this dose schedule and total dose, is superior to conventional RT. Cancer 1993; 72:1414‐21.

Expression of glioma-associated antigens in pediatric brain stem and non-brain stem gliomas

“…Given the paucity of information about the biology of brain stem gliomas, it is often necessary to make inferences about their molecular characteristics based on studies of pediatric highgrade gliomas at non-brain stem sites. Other than radiation therapy, no other therapy has demonstrated efficacy in prolonging the survival of these patients [8].…”

Secondary dissemination in children with high-grade malignant gliomas and diffuse intrinsic pontine gliomas

“…Most reports on tumour dissemination of HGG and DIPG after diagnosis, so called secondary dissemination of disease (SDD), are case reports or small series; few reports include large numbers of patients (Packer et al, 1985(Packer et al, , 1990(Packer et al, , 1993Dropcho et al, 1987;Vertosick and Selker, 1990;Grabb et al, 1992;Arita et al, 1994;Heideman et al, 1997;Donahue et al 1998;Allen et al, 1999;Endo et al, 2003;Saito et al, 2003). These series mostly come from the late 1980s and early 1990s, when MRI was not routinely available for follow-up investigations (Awad et al, 1986;Vertosick and Selker, 1990;Arita et al, 1994).…”

Treatment of high-grade glioma in children

“…[24,25] CCG-9941 çalışmasında; RT öncesi KT ve ardından hiperfraksiyone RT verilmiş yaşam sü-resi sadece konvansiyonel RT verilen grupla benzer bulunmuştur. [24] Massimino ve ark., [26] 1987-2005 arasında, 62 çocukta yaptıkları 4 pilot protokolün (A-Konvansiyonel KT RT-VP-16/sitosin arabinosid/Ifosfamid/sisplatin/daktinomisi; B-Yüksek Doz KT ve +ABMT+RT+KT; C-sisplatin/etoposid sonrası isotretinoin (preRT+RT+postRT ile eş-zamanlı); D-Vinorelbine (preRT+RT+postRT ile eşzamanlı) sonucunda, hiçbir protokolün yaşam oranları açısından literatürle karşılaştırıldığında bir üstünlük getirmediği görülmüştür (1 yıllık yaşam oranı %45, median yaşam oranı 11 ay).…”