Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

References

    1. Fangusaro J (2012) Pediatric high grade glioma: a review and update on tumor clinical characteristics and biology. Front Oncol 2:1–10. https://doi.org/10.3389/fonc.2012.00105 - DOI
    1. MacDonald TJ, Aguilera D, Kramm CM (2011) Treatment of high-grade glioma in children and adolescents. Neuro Oncol 13:1049–1058. https://doi.org/10.1093/neuonc/nor092 - DOI - PubMed - PMC
    1. Kline C, Felton E, Allen IE, Tahir P, Mueller S (2018) Survival outcomes in pediatric recurrent high-grade glioma: results of a 20-year systematic review and meta-analysis. J Neurooncol 137:103–110. https://doi.org/10.1007/s11060-017-2701-8 - DOI - PubMed
    1. Sturm D, Pfister SM, Jones DTW (2017) Pediatric gliomas: current concepts on diagnosis, biology, and clinical management. J Clin Oncol 35:2370–2377. https://doi.org/10.1200/JCO.2017.73.0242 - DOI - PubMed
    1. Cohen AR (2022) Brain tumors in children. N Engl J Med 386:1922–1931. https://doi.org/10.1056/NEJMra2116344 - DOI - PubMed

LinkOut - more resources