Hypofractionation vs conventional radiation therapy for newly diagnosed diffuse intrinsic pontine glioma: a matched-cohort analysis.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.janssens@rther.umcn.nl
Geert O
GO
Janssens
Marc H
MH
Jansen
Selmer J
SJ
Lauwers
Peter J
PJ
Nowak
Foppe R
FR
Oldenburger
Eric
E
Bouffet
Frank
F
Saran
Karin
K
Kamphuis-van Ulzen
Erik J
EJ
van Lindert
Jolanda H
JH
Schieving
Tom
T
Boterberg
Gertjan J
GJ
Kaspers
Paul N
PN
Span
Johannes H
JH
Kaanders
Corrie E
CE
Gidding
Darren
D
Hargrave
D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D017785:Photons / Q000627:therapeutic use; D011149:Pons / Q000473:pathology; D018709:Statistics, Nonparametric; D015996:Survival Rate