title: Treatment of recurrent diffuse intrinsic pontine glioma: the MD Anderson Cancer Center experience.
abstract: Recurrent diffuse intrinsic pontine gliomas (DIPG) are traditionally treated with palliative care since no effective treatments have been described for these tumors. Recently, clinical studies have been emerging, and individualized treatment is attempted more frequently. However, an informative way to compare the treatment outcomes has not been established, and historical control data are missing for recurrent disease. We conducted a retrospective chart review of patients with recurrent DIPG treated between 1998 and 2010. Response progression-free survival and possible influencing factors were evaluated. Thirty-one patients were identified who were treated in 61 treatment attempts using 26 treatment elements in 31 different regimens. The most frequently used drugs were etoposide (14), bevacizumab (13), irinotecan (13), nimotuzumab (13), and valproic acid (13). Seven patients had repeat radiation therapy to the primary tumor. Response was recorded after 58 treatment attempts and was comprised of 0 treatment attempts with complete responses, 7 with partial responses, 20 with stable diseases, and 31 with progressive diseases The median progression-free survival after treatment start was 0.16 years (2 months) and was found to be correlated to the prior time to progression but not to the number of previous treatment attempts. Repeat radiation resulted in the highest response rates (4/7), and the longest progression-free survival. These data provide a basis to plan future clinical trials for recurrent DIPG. Repeat radiation therapy should be tested in a prospective clinical study.
authors.affiliation: Department of Pediatrics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 87, Houston, TX 77030, USA. jwolff@tuftsmedicalcenter.org
authors.forename: Johannes E
authors.initials: JE
authors.lastname: Wolff
authors.forename: Michael E
authors.initials: ME
authors.lastname: Rytting
authors.forename: Tribhawan S
authors.initials: TS
authors.lastname: Vats
authors.forename: Peter E
authors.initials: PE
authors.lastname: Zage
authors.forename: Joann L
authors.initials: JL
authors.lastname: Ater
authors.forename: Shiao
authors.initials: S
authors.lastname: Woo
authors.forename: John
authors.initials: J
authors.lastname: Kuttesch
authors.forename: Leena
authors.initials: L
authors.lastname: Ketonen
authors.forename: Anita
authors.initials: A
authors.lastname: Mahajan
mesh_terms: D020295:Brain Stem Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011149:Pons / Q000473:pathology*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome