title: The role of hypofractionation radiotherapy for diffuse intrinsic brainstem glioma in children: a pilot study.
abstract: OBJECTIVE
  Most children with a diffuse intrinsic brainstem glioma will die within 1 year after diagnosis. To reduce patient burden, we investigated the feasibility of a radical hypofractionation radiotherapy schedule, given over 3 weeks, as an alternative to the standard regimen (30 fractions over 6 weeks).
  
  
  METHODS
  Nine children, ages 3-13, were treated by 13 fractions of 3 Gy (n = 8) or 6 fractions of 5.5 Gy (n = 1) given over 3 weeks. All patients had symptoms for <or=3 months and >or=2 signs of the neurologic triad (long tract signs, ataxia, cranial nerve deficit). Bilateral involvement of the pons (n = 8), encasement of the basilar artery (n = 7) and extension into the cerebellar peduncle (n = 6) was visible on magnetic resonance imaging.
  
  
  RESULTS
  Symptom improvement occurred in all patients within 2 weeks after start of radiotherapy. At a mean follow-up time of 15 months, 7 patients have died. Median time to progression and overall survival was 4.9 and 8.6 months, respectively. Median time to death after progression was 3.6 months. No Grade 3 or 4 toxicity was observed. In a recently published review of clinical trials, median time to progression, overall survival, and time between progression and death ranged from 5.0-8.8, 7.0-16, and 1.0-4.5 months, respectively, with more aggressive regimens.
  
  
  CONCLUSIONS
  This radical hypofractionation radiotherapy regimen for children with diffuse intrinsic brainstem glioma is feasible and associated with no Grade 3 or 4 toxicities. With a minimal overall treatment time, it offers quick symptom relief and outcome results within the range of published data.
authors.affiliation: Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.janssens@rther.umcn.nl
authors.forename: Geert O R J
authors.initials: GO
authors.lastname: Janssens
authors.forename: Corrie E M
authors.initials: CE
authors.lastname: Gidding
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Van Lindert
authors.forename: Foppe R
authors.initials: FR
authors.lastname: Oldenburger
authors.forename: Corrie E
authors.initials: CE
authors.lastname: Erasmus
authors.forename: Antoinette Y N
authors.initials: AY
authors.lastname: Schouten-Meeteren
authors.forename: Johannes H A M
authors.initials: JH
authors.lastname: Kaanders
mesh_terms: D000293:Adolescent; D001706:Biopsy; D001933:Brain Stem / Q000473:pathology; D020295:Brain Stem Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011880:Radiotherapy Planning, Computer-Assisted; D016019:Survival Analysis; D016896:Treatment Outcome