Late Effects After Radiotherapy for Childhood Low-grade Glioma

Williams, Noelle L.; Rotondo, Ronny L.; Bradley, Julie A.; Pincus, David W.; Fort, John; Wynn, Tung; Morris, Christopher G.; Mendenhall, Nancy P.; Indelicato, Daniel J.

doi:10.1097/coc.0000000000000267

Cited by 33 publications

(22 citation statements)

References 19 publications

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“…As demonstrated by a previous institutional report, serious toxicity can be observed decades after radiation in LGG survivors. 1 Although we observed just 1 second malignancy, it is too soon to empirically demonstrate a benefit for proton therapy in this important domain. Neurocognitive outcomes will likewise require years to validate the dosimetric promise of proton therapy for LGGs.…”

Section: Freedom From Event (%)mentioning

confidence: 81%

“…Treatment side effects can be permanent or life threatening and include neurocognitive impairment, neurologic deficits, neurovascular compromise, neuroendocrine deficiency, and second malignancies. 1 Surgery, radiation therapy, and chemotherapy may be used as solitary therapies or in combination, offering different therapeutic ratios depending on the setting. As a result, establishing the ideal treatment choice and sequencing has historically been an area of controversy, presenting challenges that are further complicated by the emergence of molecular targets.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes Following Proton Therapy for Pediatric Low-Grade Glioma

Indelicato

Rotondo

Uezono

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Our cohort of 174 pediatric patients with low-grade glioma demonstrated progression-free survival and overall survival rates of 84% and 92%, respectively, after proton therapy. These survival rates are similar to those of contemporary photon cohorts. Data from this prospective study inform radiation technique and overall patient management for the most common pediatric brain tumor. Purpose: Dosimetric studies show that proton therapy can reduce the low/intermediate radiation dose to uninvolved tissue in children with low-grade glioma (LGG). For this reason, LGG is the fourth most common pediatric tumor treated with proton therapy, yet clinical outcome data on efficacy and toxicity are limited. Methods and Materials: We reviewed the medical records of 174 children (21 years old) with nonmetastatic LGG enrolled on a prospective protocol and treated with proton therapy between 2007 and 2017. We assessed clinical outcomes and toxicity and analyzed patient, tumor, and treatment-related variables. Results: The median age was 10.2 years (range, 2-21). Fifty-eight percent of tumors were World Health Organization grade 1 and 30% were grade 2; 12% were diagnosed on imaging characteristics alone. The most common histology was pilocytic astrocytoma (47%). The most common tumor subsites were diencephalon/optic pathway (52%), caudal brainstem (16%), and cerebellum (13%). Forty-two percent received chemotherapy before radiation therapy. The median follow-up was 4.4 years. The 5year actuarial rates of local control, progression-free survival, and overall survival were 85% (95% confidence interval [CI], 78%-90%), 84% (95% CI, 77%-89%), and 92% (95% CI, 85%-95%), respectively. On univariate analysis, brainstem/spinal cord tumor location (62% vs 90% elsewhere) and dose <54 GyRBE (67% vs 91% for 54 GyRBE) were associated with inferior local control (P < .01 for both). Twenty-two patients (12.6%) experienced acute nausea or vomiting requiring ondansetron; 2 patients (1.1%) required corticosteroids. Serious toxicities (4% of patients)

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Section: Freedom From Event (%)mentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Outcomes Following Proton Therapy for Pediatric Low-Grade Glioma

Indelicato

Rotondo

Uezono

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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“…Однако в то же время существенной проблемой становится возникновение поздних постлучевых изменений в головном мозге и критических структурах, расположенных интракраниально. Результатами таких изменений являются нарушение нейрокогнитивной функции, проблемы в социальной адаптации, нейроэндокринные нарушения, сосудистые изменения в головном мозге и вторичные опухоли [28][29][30].…”

Section: протонная терапияunclassified

Comparison of the Effectiveness of Proton and Photon Therapy in Patients With Brain Tumors

2021

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Owing to the development of molecular genetics, the role of radiation therapy and chemotherapy in treatment of patients with glioma (WHO Grade I–IV) has become more understandable. The overall survival among glioma patients has increased. As overall survival increases, oncologists are more likely to detect manifestations of late radiation toxicity that has a huge impact on Quality of Life in patients who have undergone radiation therapy in the past. In this regard, the question of finding more adequate radiation therapy techniques remains relevant. photon radiation therapy is the standard method; however, considering dosimetric advantages of proton therapy over photon therapy, its widespread use can potentially lead to the increased overall survival, decreased number of late radiation-induced complications and improved quality of life in the post-radiation period. This article presents some comparative characteristics of proton and photon radiation therapy in patients with gliomas (WHO Grade I–IV). dosimetry characteristics of protons in tissues were compared, data showing differences in survival of patients treated with photons versus patients treated with protons were presented, and general information on early and late radiation-induced toxicity arising from the treatment by these methods was disclosed.

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“…LGGs also account for the majority of pediatric central nervous system tumours [2]. The 2016 WHO classification [3] redefines grade II gliomas with respect to morphological and molecular tumor alterations, the latter ones displaying a higher correlation with prognosis and therapy response [4].…”

Section: Radiation Protraction Schedules For Low-grade Gliomas: a Commentioning

confidence: 99%

Radiation protraction schedules for low-grade gliomas: a comparison between different mathematical models

Budia

Álvarez-Arenas

Woolley

et al. 2019

J. R. Soc. Interface.

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We optimize radiotherapy (RT) administration strategies for treating low-grade gliomas. Specifically, we consider different tumour growth laws, both with and without spatial effects. In each scenario, we find the optimal treatment in the sense of maximizing the overall survival time of a virtual low-grade glioma patient, whose tumour progresses according to the examined growth laws. We discover that an extreme protraction therapeutic strategy, which amounts to substantially extending the time interval between RT sessions, may lead to better tumour control. The clinical implications of our results are also presented.

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Late Effects After Radiotherapy for Childhood Low-grade Glioma

Abstract: Over half of children diagnosed with LGG survive >20 years after RT; this report reveals the chronicity of toxicity beyond the typically reported follow-up. Our findings inform the therapeutic ratio of RT in this disease and may help guide late-effect screening recommendations.

Cited by 33 publications

References 19 publications

Outcomes Following Proton Therapy for Pediatric Low-Grade Glioma

Outcomes Following Proton Therapy for Pediatric Low-Grade Glioma

Comparison of the Effectiveness of Proton and Photon Therapy in Patients With Brain Tumors

Radiation protraction schedules for low-grade gliomas: a comparison between different mathematical models

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