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. 2022 Sep;159(2):437-445.
doi: 10.1007/s11060-022-04079-4. Epub 2022 Jul 9.

How ten-years of reirradiation for paediatric high-grade glioma may shed light on first line treatment

Maura Massimino #  1 , Sabina Vennarini #  2 , Francesco Barretta  3 , Francesca Colombo  4 , Manila Antonelli  5 , Bianca Pollo  6 , Emanuele Pignoli  7 , Emilia Pecori  2 , Ombretta Alessandro  2 , Elisabetta Schiavello  8 , Luna Boschetti  8 , Marta Podda  8 , Nadia Puma  8 , Giovanna Gattuso  8 , Giovanna Sironi  8 , Elena Barzanò  8 , Olga Nigro  8 , Luca Bergamaschi  8 , Stefano Chiaravalli  8 , Roberto Luksch  8 , Cristina Meazza  8 , Filippo Spreafico  8 , Monica Terenziani  8 , Michela Casanova  8 , Andrea Ferrari  8 , Marco Chisari  9 , Chiara Pellegrini  9 , Carlo Alfredo Clerici  8   10 , Piergiorgio Modena  11 , Veronica Biassoni  8
Affiliations

How ten-years of reirradiation for paediatric high-grade glioma may shed light on first line treatment

Maura Massimino et al. J Neurooncol. 2022 Sep.

Abstract

Purpose: Recurrence incidence for paediatric/adolescent high-grade glioma (HGG) exceeds 80%. Reirradiation (reRT) palliates symptoms and delays further progression. Strategies for reRT are scarce: we retrospectively analysed our series to develop rational future approaches.

Methods: We re-evaluated MRI + RT plans of 21 relapsed HGG-patients, accrued 2010-2021, aged under 18 years. All underwent surgery and RT + chemotherapy at diagnosis. Pathologic/molecular re-evaluation allowed classification based on WHO 2021 criteria in 20/21 patients. Survival analyses and association with clinical parameters were performed.

Results: Relapse after 1st RT was local in 12 (7 marginal), 4 disseminated, 5 local + disseminated. Re-RT obtained 8 SD, 1 PR, 1PsPD, 1 mixed response, 10 PD; neurological signs/symptoms improved in 8. Local reRT was given to 12, followed again by 6 local (2 marginal) and 4 local + disseminated second relapses in 10/12 re-evaluated. The 4 with dissemination had 1 whole brain, 2 craniospinal irradiation (CSI), 1 spine reRT and further relapsed with dissemination and local + dissemination in 3/four assessed. Five local + disseminated tumours had 3 CSI, 1 spine reRT, further progressing locally (2), disseminated (1), n.a. (1). Three had a third RT; three were alive at 19.4, 29, 50.3 months after diagnosis. Median times to progression/survival after re-RT were 3.7 months (0.6-16.2 months)/6.9 months (0.6-17.9 months), improved for longer interval between 1st RT and re-RT (P = 0.017) and for non-PD after reRT (P < 0.001). First marginal relapse showed potential association with dissemination after re-RT (P = 0.081).

Conclusions: This is the biggest series of re-RT in paediatric HGG. Considering the dissemination observed at relapse, our results could prompt the investigation of different first RT fields in a randomized trial.

Keywords: 5th WHO classification; Dissemination; Pediatric high-grade glioma; Reirradiation.

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