Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis

• DOI: 10.1016/j.ijrobp.2012.04.006
• Publication Date: 2013-01-09T10:40:00Z
• Authors: Geert O. Janssens; Marc H. Jansen; Selmer J. Lauwers; Peter J. Nowak; Foppe R. Oldenburger; Eric Bouffet; Frank Saran; Karin Kamphuis-va...; Erik J. van Lindert; Jolanda H. Schieving; Tom Boterberg; Gertjan J. Kaspers; Paul N. Span; Johannes H. Kaanders; Corrie E. Gidding; Darren Hargrave
• Keywords: Male; Adolescent; DCN MP - Plasticity and memory; Matched-Pair Analysis; Statistics, Nonparametric; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Pons; ONCOL 2: Age-related aspects of cancer; Medical Imaging - Radboud University Medical Center; Brain Stem Neoplasms; Humans; Child; Photons; IGMD 6: Hormonal regulation ONCOL 5: Aetiology, screening and detection; NCEBP 2: Evaluation of complex medical interventions ONCOL 5: Aetiology, screening and detection; Glioma; ONCOL 5: Aetiology, screening and detection; 3. Good health; Survival Rate; Laboratory Medicine - Radboud University Medical Center; ONCOL 3: Translational research; Child, Preschool; Female; Dose Fractionation, Radiation

Despite conventional radiation therapy, 54 Gy in single doses of 1.8 Gy (54/1.8 Gy) over 6 weeks, most children with diffuse intrinsic pontine glioma (DIPG) will die within 1 year after diagnosis. To reduce patient burden, we investigated the role of hypofractionation radiation therapy given over 3 to 4 weeks. A 1:1 matched-cohort analysis with conventional radiation therapy was performed to assess response and survival.Twenty-seven children, aged 3 to 14, were treated according to 1 of 2 hypofractionation regimens over 3 to 4 weeks (39/3 Gy, n=16 or 44.8/2.8 Gy, n=11). All patients had symptoms for ≤3 months, ≥2 signs of the neurologic triad (cranial nerve deficit, ataxia, long tract signs), and characteristic features of DIPG on magnetic resonance imaging. Twenty-seven patients fulfilling the same diagnostic criteria and receiving at least 50/1.8 to 2.0 Gy were eligible for the matched-cohort analysis.With hypofractionation radiation therapy, the overall survival at 6, 9, and 12 months was 74%, 44%, and 22%, respectively. Progression-free survival at 3, 6, and 9 months was 77%, 43%, and 12%, respectively. Temporary discontinuation of steroids was observed in 21 of 27 (78%) patients. No significant difference in median overall survival (9.0 vs 9.4 months; P=.84) and time to progression (5.0 vs 7.6 months; P=.24) was observed between hypofractionation vs conventional radiation therapy, respectively.For patients with newly diagnosed DIPG, a hypofractionation regimen, given over 3 to 4 weeks, offers equal overall survival with less treatment burden compared with a conventional regimen of 6 weeks.