Hypofractionated radiotherapy versus conventional radiotherapy for diffuse intrinsic pontine glioma

Park, Jae Won; Yea, Ji Woon

doi:10.1097/md.0000000000022721

Cited by 12 publications

(6 citation statements)

References 34 publications

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“…Hypofractionated radiotherapy with temozolomide did not improve survival outcomes and accompanied higher hematologic toxicity compared to conventional fractionated radiotherapy. A recently published meta-analysis performed to overcome the small sample size of previous studies included 4 articles, involving 88 patients undergoing hypofractionated radiotherapy and 96 patients undergoing conventional fractionation radiotherapy [ 31 ]. It revealed that hypofractionated and conventional fractionation radiotherapy provided comparable OS (HR=1.07, 95% CI: 0.77–1.47) and PFS (HR= 1.04, 95% CI: 0.75–1.45) and had similar toxicity profiles.…”

Section: Radiotherapy Approachmentioning

confidence: 99%

Radiotherapy for Diffuse Intrinsic Pontine Glioma: Insufficient but Indispensable

Kim

Suh

2023

Brain Tumor Res Treat

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Diffuse intrinsic pontine gliomas (DIPGs) account for 10%–20% of all central nervous system tumors in children and are the leading cause of death in children with brain tumors. Although many clinical trials have been conducted over the past decades, the survival outcome has remained unchanged. Over 90% of children die within 2 years of the diagnosis, and radiotherapy remains the standard treatment to date. To improve the prognosis, hyperfractionated and hypofractionated radiotherapy and/or addition of radiosensitizers have been investigated. However, none of the radiotherapy approaches have shown a survival benefit, and the overall survival of patients with DIPG is approximately 11 months. Here, we comprehensively review the management of DIPG with focus on radiotherapy.

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Section: Radiotherapy Approachmentioning

confidence: 99%

Radiotherapy for Diffuse Intrinsic Pontine Glioma: Insufficient but Indispensable

Kim

Suh

2023

Brain Tumor Res Treat

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“…A recent meta-analysis by Trone and colleagues in first line GB revealed that hypofractionation lead to comparable survival outcomes-overall survival and progression free survival-with the benefit of a shortened duration of treatment [6]. Similar conclusions have been reported in the elderly GB [7] and paediatric diffuse midline glioma patient populations [8]. While hypofractionated RT regimens have been examined in the clinic, the mechanism of action from differential fractionated regimens are often not explored preclinically to elucidate wherein we may better reduce delayed neurological symptoms associated with radiotoxicity.…”

Section: Introductionmentioning

confidence: 57%

Differential effects of radiation fractionation regimens on glioblastoma

et al. 2022

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Background Radiotherapy (RT) is a mainstay of treatment for patients with glioblastoma (GB). Early clinical trials show that short course hypofractionation showed no survival benefit compared to conventional regimens with or without temozolomide chemotherapy (TMZ) but reduces the number of doses required. Concerns around delayed neurological deficits and reduced cognition from short course hypofractionated RT remain a concern. The aim of this study was to evaluate the effect of increased interfractional time using two different radiation fractionation regimens on GB. Methods The radiobiological effect of increasing doses 0–20 Gy x-ray photon RT on Gl261 and CT2A GB cell lines was compared by colony forming assay, DNA damage by alkaline comet assay, oxidative stress, DNA damage, cell cycle, and caspase-3/7 by MUSE® flow cytometric analyses, and protein expression by western blot analyses. Conventional (20 Gy/10 fractions) and hypofractionated (20 Gy/4 fractions spaced 72 h apart) RT regimens with and without TMZ (200 mg/kg/day) were performed in syngeneic Gl261 and CT2A intracranial mouse models using the Small Animal Radiation Research Platform (Xstrahl Inc.). Results X-ray photon radiation dose-dependently increased reactive oxygen species, DNA damage, autophagy, and caspase 3/7-mediated apoptotic cell death. While the conventional fractionated dose regimen of 20 Gy/10 f was effective at inducing cell death via the above mechanism, this was exceeded by a 20 Gy/4 f regimen which improved median survival and histopathology in Gl261-tumor bearing mice, and eradicated tumors in CT2A tumors with no additional toxicity. Conclusions Spacing of hypofractionated RT doses 72 h apart showed increased median survival and tumor control via increased activation of RT-mediated cell death, with no observed increased in radiotoxicity. This supports further exploration of differential RT fractionated regimens in GB clinical trials to reduce delayed neurological radiotoxicity.

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“…Hyperfractionated RT has shown potential in improving clinical management by caregivers and has a significant positive impact on the quality of life for patients with DMG [ 8 , 15 ]. In contrast, a study by Park et al (2020) compared hyperfractionated therapy with standard RT and found similar survival outcomes for patients with DMG [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

Epidemiology, Diagnostic Strategies, and Therapeutic Advances in Diffuse Midline Glioma

Miguel Llordes,

Medina Pérez,

Curto Simón

et al. 2023

JCM

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Object: Diffuse midline glioma (DMG) is a highly aggressive and lethal brain tumor predominantly affecting children and young adults. Previously known as diffuse intrinsic pontine glioma (DIPG) or grade IV brain stem glioma, DMG has recently been reclassified as “diffuse midline glioma” according to the WHO CNS5 nomenclature, expanding the DMG demographic. Limited therapeutic options result in a poor prognosis, despite advances in diagnosis and treatment. Radiotherapy has historically been the primary treatment modality to improve patient survival. Methods: This systematic literature review aims to comprehensively compile information on the diagnosis and treatment of DMG from 1 January 2012 to 31 July 2023. The review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and utilized databases such as PubMed, Cochrane Library, and SciELO. Results: Currently, molecular classification of DMG plays an increasingly vital role in determining prognosis and treatment options. Emerging therapeutic avenues, including immunomodulatory agents, anti-GD2 CAR T-cell and anti-GD2 CAR-NK therapies, techniques to increase blood–brain barrier permeability, isocitrate dehydrogenase inhibitors, oncolytic and peptide vaccines, are being explored based on the tumor’s molecular composition. However, more clinical trials are required to establish solid guidelines for toxicity, dosage, and efficacy. Conclusions: The identification of the H3K27 genetic mutation has led to the reclassification of certain midline tumors, expanding the DMG demographic. The field of DMG research continues to evolve, with encouraging findings that underscore the importance of highly specific and tailored therapeutic strategies to achieve therapeutic success.

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Hypofractionated radiotherapy versus conventional radiotherapy for diffuse intrinsic pontine glioma

Cited by 12 publications

References 34 publications

Radiotherapy for Diffuse Intrinsic Pontine Glioma: Insufficient but Indispensable

Radiotherapy for Diffuse Intrinsic Pontine Glioma: Insufficient but Indispensable

Differential effects of radiation fractionation regimens on glioblastoma

Epidemiology, Diagnostic Strategies, and Therapeutic Advances in Diffuse Midline Glioma

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