title: Pre-radiation chemotherapy improves survival in pediatric diffuse intrinsic pontine gliomas.
abstract: BACKGROUND
  The median survival of patients with diffuse intrinsic pontine glioma (DIPG) remains less than 1 year. The BSG 98 pre-irradiation chemotherapy protocol showed a significant increase in overall survival. In contrast to current treatment strategies, patients did not have to undergo surgical stereotactic biopsy, which can sometimes lead to complications, to be included in this protocol.
  
  
  METHODS
  We retrospectively reviewed all the cases of DIPG that were treated in our department from September 15, 2004 to September 15, 2014. We compared the group of patients who followed our BSG 98 protocol to those who were treated with new targeted therapy protocols where systematic biopsy was required.
  
  
  RESULTS
  Patients in the BSG 98 protocol were treated with BCNU, cisplatin, and methotrexate, followed by radiation at disease progression. Targeted therapy protocols included radiation therapy along with treatment by erlotinib, cilengitide, or an association of nimotuzumab and vinblastine. Sixteen patients were treated with the BSG 98 protocol, and 9 patients were treated with new targeted therapy protocols. Median overall survival was significantly higher in the BSG 98 group compared to the targeted therapy group (16.1 months (95 % CI, 10.4-19.0) vs 8.8 months (95 % CI 1.4-12.3); p = 0.0003). An increase in the median progression-free survival was observed (respectively, 8.6 vs 3.0 months; p = 0.113).
  
  
  CONCLUSIONS
  The present study confirms that the BSG 98 protocol is one of the most effective current treatment strategies for DIPG. It may be used as the control arm in randomized trials investigating the use of innovative treatments and may be proposed to families who are averse to biopsy.
authors.affiliation: Department of Pediatric Hematology and Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Gokce-Samar
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Hospice Civils de Lyon, 59 Boulevard Pinel, 69677, Lyon cedex, France. pierre-aurelien.beuriat@neurochirurgie.fr.
authors.forename: P A
authors.initials: PA
authors.lastname: Beuriat
authors.affiliation: Department of Pediatric Hematology and Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Faure-Conter
authors.affiliation: Department of Radiotherapy, Centre Léon Bérard, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Carrie
authors.affiliation: Department of Biostatistics, Centre Léon Bérard, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Chabaud
authors.affiliation: Department of Radiotherapy, Centre Léon Bérard, Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Claude
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Hospice Civils de Lyon, 59 Boulevard Pinel, 69677, Lyon cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Di Rocco
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Hospice Civils de Lyon, 59 Boulevard Pinel, 69677, Lyon cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Mottolese
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre Wertheimer, Hospice Civils de Lyon, 59 Boulevard Pinel, 69677, Lyon cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Szathmari
authors.affiliation: Department of Radiology, Centre Léon Bérard, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Chabert
authors.affiliation: Department of Pediatric Hematology and Oncology, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France.|Department of Oncology, Centre Léon Bérard, Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Frappaz
mesh_terms: D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chemotherapy; Diffuse intrinsic pontine glioma; Pediatric; Radiotherapy; Stereotactic biopsy; Targeted therapy