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Neurological Symptom Improvement After Re-Irradiation in Patients With Diffuse Intrinsic Pontine Glioma : A Retrospective Analysis of the SIOP-E-HGG/DIPG Project

Published inFrontiers in oncology, vol. 12, 926196
Publication date2022
First online date2022-06-22
Abstract

Purpose: The aim of this study is to investigate the spectrum of neurological triad improvement in patients with diffuse intrinsic pontine glioma (DIPG) treated by re-irradiation (re-RT) at first progression.

Methods: We carried out a re-analysis of the SIOP-E retrospective DIPG cohort by investigating the clinical benefits after re-RT with a focus on the neurological triad (cranial nerve deficits, ataxia, and long tract signs). Patients were categorized as "responding" or "non-responding" to re-RT. To assess the interdependence between patients' characteristics and clinical benefits, we used a chi-square or Fisher's exact test. Survival according to clinical response to re-RT was calculated by the Kaplan-Meier method.

Results: As earlier reported, 77% (n= 24/31) of patients had any clinical benefit after re-RT. Among 25/31 well-documented patients, 44% (n= 11/25) had improvement in cranial nerve palsies, 40% (n= 10/25) had improvement in long-tract signs, and 44% (11/25) had improvement in cerebellar signs. Clinical benefits were observed in at least 1, 2, or 3 out of 3 symptoms of the DIPG triad, in 64%, 40%, and 24%, respectively. Patients irradiated with a dose ≥20 Gy versus <20 Gy may improve slightly better with regard to ataxia (67% versus 23%;p-value = 0.028). The survival from the start of re-RT to death was not different between responding and non-responding DIPG patients (p-value = 0.871).

Conclusion: A median re-irradiation dose of 20 Gy provides a neurological benefit in two-thirds of patients with an improvement of at least one symptom of the triad. DIPG patients receiving ≥20 Gy appear to improve slightly better with regard to ataxia; however, we need more data to determine whether dose escalation up to 30 Gy provides additional benefits.

eng
Keywords
  • Adolescent
  • Child
  • Diffuse intrinsic pontine glioma (DIPG)
  • Radiotherapy
  • Re-irradiation (re-RT)
Citation (ISO format)
CHAVAZ, Lara Marie et al. Neurological Symptom Improvement After Re-Irradiation in Patients With Diffuse Intrinsic Pontine Glioma : A Retrospective Analysis of the SIOP-E-HGG/DIPG Project. In: Frontiers in oncology, 2022, vol. 12, p. 926196. doi: 10.3389/fonc.2022.926196
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ISSN of the journal2234-943X
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