Reirradiation and Re-reirradiation of Pediatric Midline Gliomas

IF 6.4 1区医学 Q1 ONCOLOGY

International Journal of Radiation Oncology Biology Physics Pub Date : 2025-02-03 DOI:10.1016/j.ijrobp.2024.11.025

A. Embring , A. Asklid , M. Nilsson , I. Kristensen , M. Blomstrand , C. Fröjd , M. Agrup , A. Flejmer , A. Svärd , J. Engellau

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引用次数: 0

Abstract

Objectives

Children with midline gliomas have a dismal prognosis and current treatment options cannot offer cure. At progression after primary radiotherapy, reirradiation can be offered to relieve symptoms. The aim of this study is to evaluate the outcome of children treated with reirradiation for midline glioma since implementing national guidelines in 2019.

Methods

All children reirradiated for midline gliomas 2019-2023 in Sweden were retrospectively analysed. A review of medical records and treatment plans was performed to collect data on clinical and treatment characteristics, severe side effects, treatment effect and survival.

Results

Eleven patients were analysed and the median age at start of first reirradiation was 9 years (4-18). The median overall survival from end of first reirradiation was 5.6 months. The median follow-up was 4 months (0-14). The most common (91%) treatment at primary irradiation was 54 Gy in 30 fractions and at first (82%) and second (75%) reirradiation it was 20 Gy in 10 fractions. The median time between first and second irradiation was 8 months (4-27) and 6 months (6-7) between second and third irradiation. The median D2% to the brainstem was 74 Gy (59-91) at first reirradiation (n=11) and 95 Gy (77-95) at second reirradiation (n=4). In patients where the indication for reirradiation was progression of symptoms, 6 patients (67%) had relief of symptoms after reirradiation, and 3 patients (75%) had relief of symptoms after re-reirradiation. No patients had grade ≥3 side effects at reirradiation. One patient had acute respiratory grade ≥3 side effect (hyperventilation) at second reirradiation but recovered after treatment with steroids.

Conclusion

The implementation of national guidelines has harmonised how paediatric midline glioma are treated with reirradiation in Sweden. A structured follow-up shows that severe side effects are rare, and that reirradiation can offer relief of symptoms for selected patients.

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来源期刊

International Journal of Radiation Oncology Biology Physics 医学-核医学

CiteScore

11.00

自引率

7.10%

发文量

2538

审稿时长

6.6 weeks

期刊介绍： International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.