title: Craniospinal irradiation with concurrent temozolomide and nimotuzumab in a child with primary metastatic diffuse intrinsic pontine glioma. A compassionate use treatment.
abstract: Primary metastatic diffuse intrinsic pontine glioma (DIPG) is relatively rare and associated with a dismal prognosis. Combining craniospinal irradiation (CSI) with concurrent temozolomide and nimotuzumab therapy may slightly improve tumor control and overall survival. However, little is known about the feasibility and toxicity of this treatment approach. Here, we describe the case of an 8-year-old girl with primary metastatic DIPG who received craniospinal radiotherapy, a local boost, and concurrent temozolomide and nimotuzumab treatment based on an individual therapy recommendation. Radiotherapy could be completed without any interruption. However, concurrent temozolomide had to be disrupted several times due to considerable acute myelotoxicity (grade III-IV).Maintenance immunochemotherapy could be started with a delay of 5 days and was performed according to treatment schedule. The disease could be stabilized for a few months. A routine MRI scan finally depicted disease progression 5.7 months after the start of irradiation. The patient died 1.9 months later.
authors.affiliation: Department of Radiation Oncology, University Medical Center Leipzig, Stephan-Str. 9a, 04103, Leipzig, Germany. Klaus.Mueller@medizin.uni-leipzig.de
authors.forename: K
authors.initials: K
authors.lastname: Müller
authors.forename: A
authors.initials: A
authors.lastname: Schlamann
authors.forename: C
authors.initials: C
authors.lastname: Seidel
authors.forename: M
authors.initials: M
authors.lastname: Warmuth-Metz
authors.forename: H
authors.initials: H
authors.lastname: Christiansen
authors.forename: D
authors.initials: D
authors.lastname: Vordermark
authors.forename: R-D
authors.initials: RD
authors.lastname: Kortmann
authors.forename: C M
authors.initials: CM
authors.lastname: Kramm
authors.forename: A O
authors.initials: AO
authors.lastname: von Bueren
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D020295:Brain Stem Neoplasms / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D002648:Child; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D017809:Fatal Outcome; D005260:Female; D005910:Glioma / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy*; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C501466:nimotuzumab; D003606:Dacarbazine; D000077204:Temozolomide