title: Hypofractionated conformal radiotherapy for pediatric diffuse intrinsic pontine glioma (DIPG): a randomized controlled trial.
abstract: BACKGROUND
  The pediatric diffuse intrinsic pontine glioma (DIPG) outcome remains dismal despite multiple therapeutic attempts.
  
  
  OBJECTIVE
  To compare the results of treatment of pediatric diffuse intrinsic pontine glioma (DIPG) using hypofractionated versus conventional radiotherapy.
  
  
  METHODS
  Seventy-one newly diagnosed DIPG children were randomized into hypofractionated (HF) (39Gy/13 fractions in 2.6weeks) and conventional (CF) arm (54Gy/30 fractions in 6weeks).
  
  
  RESULTS
  The median and one-year overall survival (OS) was 7.8months and 36.4±8.2% for the hypofractionated arm, and 9.5 and 26.2±7.4% for the conventional arm respectively. The 18-month OS difference was 2.2%. The OS hazard ratio (HR) was 1.14 (95% CI: 0.70-1.89) (p=0.59). The hypofractionated arm had a median and one-year progression-free survival (PFS) of 6.6months and 22.5±7.1%, compared to 7.3 and 17.9±7.1% for the conventional arm. The PFS HR was 1.10 (95% CI: 0.67-1.90) (p=0.71). The 18-month PFS difference was 1.1%. These differences exceed the non-inferiority margin. The immediate and delayed side effects were not different in the 2 arms.
  
  
  CONCLUSIONS
  Hypofractionated radiotherapy offers lesser burden on the patients, their families and the treating departments, with nearly comparable results to conventional fractionation, though not fulfilling the non-inferiority assumption.
authors.affiliation: Radiation Oncology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt. Electronic address: mszagh@yahoo.com.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Zaghloul
authors.affiliation: Radiation Oncology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: Eldebawy
authors.affiliation: Radiation Oncology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt.
authors.forename: Soha
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Radiation Oncology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt.
authors.forename: Amr G
authors.initials: AG
authors.lastname: Mousa
authors.affiliation: Radiation Oncology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Amin
authors.affiliation: Radiology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt.
authors.forename: Amal
authors.initials: A
authors.lastname: Refaat
authors.affiliation: Radiology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt.
authors.forename: Iman
authors.initials: I
authors.lastname: Zaky
authors.affiliation: Research Department, Children's Cancer Hospital, Egypt.
authors.forename: Nada
authors.initials: N
authors.lastname: Elkhateeb
authors.affiliation: Research Department, Children's Cancer Hospital, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sabry
mesh_terms: D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005910:Glioma / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D015996:Survival Rate
keywords: DIPG; Diffuse intrinsic pontine glioma; Hypofractionation; Overall and progression-free survival