Palliative Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma

Fontanilla, Hiral P.; Pinnix, Chelsea C.; Ketonen, Leena; Woo, Shiao Y.; Vats, Tribhawan S.; Rytting, Michael; Wolff, Johannes; Mahajan, Anita

doi:10.1097/coc.0b013e318201a2b7

Cited by 71 publications

(53 citation statements)

References 31 publications

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“…Three previous reports have described the outcome of patients whose treatment of recurrent disease included rRT . In the first, from MD Anderson Cancer Center, five patients were treated with rRT using either 18 Gy in 10 fractions (one patient) or 20 Gy in 10 fractions (four patients), and concurrent chemotherapy after a second or subsequent progression following initial treatment.…”

Section: Discussionmentioning

confidence: 99%

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Reirradiation in patients with diffuse intrinsic pontine gliomas: The Canadian experience

Lassaletta

Strother

Laperrière

et al. 2018

Pediatric Blood & Cancer

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Section: Discussionmentioning

confidence: 99%

“…Lansky performance scores increased in two of five patients and remained stable in the other three patients. Median time to progression after rRT was 5 months . In the second report by investigators from Italy, rRT was built into a phase II study of radiation plus nimotuzumab and vinorelbine for newly diagnosed DIPG patients.…”

Section: Discussionmentioning

confidence: 99%

Reirradiation in patients with diffuse intrinsic pontine gliomas: The Canadian experience

Lassaletta

Strother

Laperrière

et al. 2018

Pediatric Blood & Cancer

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“…Re-irradiation significantly increases risks of radiation toxicity at doses >64 Gy (Bartels et al, 2011) without improving survival outcomes (Fontanilla et al, 2012; Susheela et al, 2013). Because DIPG biology appears to shift from initial diagnosis to tumor progression (Wolff et al, 2012), re-planning of therapy may be warranted (Chris Beltran, 2011).…”

Section: Progess In Traditional Treatments For Dipgmentioning

confidence: 99%

Potential New Therapies for Pediatric Diffuse Intrinsic Pontine Glioma

et al. 2017

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Diffuse intrinsic pontine glioma (DIPG) is an extensively invasive malignancy with infiltration into other regions of the brainstem. Although large numbers of specific targeted therapies have been tested, no significant progress has been made in treating these high-grade gliomas. Therefore, the identification of new therapeutic approaches is of great importance for the development of more effective treatments. This article reviews the conventional therapies and new potential therapeutic approaches for DIPG, including epigenetic therapy, immunotherapy, and the combination of stem cells with nanoparticle delivery systems.

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“…Table II shows examples of possible fractionation regimens. A maximum dose of 20 Gy with concurrent chemotherapy has been prescribed in patients with diffuse intrinsic pontine glioma (99). This modest dose improved symptoms and delayed progression with minimal side-effects.…”

Section: Resultsmentioning

confidence: 99%

Re-irradiation for Recurrent Primary Brain Tumors

Nieder

Andratschke

Grosu

2016

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Abstract. Background: Historically, radiation oncologists have been cautious about re-irradiating brain tumors because of concerns about the risks of late central nervous system (CNS) toxicity, especially radionecrosis, that may occur several months to years following treatment. Today there are still limited prospective data addressing this approach. Materials and Methods: Systematic review of published trials reporting clinical results after re-irradiation of patients with different types of brain tumors was performed. Results: Data mainly related to glioblastoma, anaplastic glioma, medulloblastoma, ependymoma and meningioma have been published. Randomized studies are scarce. As in first-line scenarios, efficacy of radiotherapy is influenced by histology. Based on the reported outcomes, preliminary recommendations for dose/fractionation regimens can be given. Conclusion: Re-irradiation of brain tumors is increasingly considered as our understanding of brain tolerance to radiation evolves and developments in radiation technology and imaging make highly accurate targeting of recurrent tumors possible. With developments in systemic therapy, further exploration of the role of re-irradiation on its own or in combination with novel agents is needed.The current postoperative standard treatment for glioblastoma (GBM) is radiotherapy with concurrent and adjuvant temozolomide. With this approach, 5-year overall survival is 9.8% compared to 1.9% with radiotherapy alone (1). Recent data suggest that maintenance therapy with tumor-treating fields in addition to temozolomide improves survival (2). Efforts have been made to standardize the target volume definition (3). Nevertheless, despite an increase in survival rates, the majority of patients progress within 10-15 months. Also for anaplastic astrocytomas and low-grade gliomas, radiotherapy remains a common first-line treatment. In these tumors, the time to progression is longer but the majority ultimately also recurs. Salvage therapy is indicated in the majority of recurrent gliomas and most patients receive systemic therapy and/or surgery at relapse.Historically, many radiation oncologists have been cautious about re-irradiating brain tumors because of concerns about the risks of toxicity, e.g., radionecrosis. Reirradiation for brain tumors is now more frequently used because developments in radiation technology and imaging allow for highly accurate targeting of biologically relevant tumor volumes and, furthermore, several studies have demonstrated the feasibility of this treatment paradigm. This review summarizes radiobiological principles behind reirradiation of different types of brain tumors and discusses the current evidence from clinical studies. Overview of Treatment Options for Recurrent GliomasExternal-beam radiotherapy is an integral part of treatment of low-and high-grade gliomas. At relapse, treatment options have included further surgical resection, systemic therapy, including prospective trials of new agents, and re-irradiation. Currently, however, there is ...

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Palliative Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma

Abstract: Reirradiation with chemotherapy may be feasible to improve symptoms and delay progression with minimal toxicity. Patients who are most likely to benefit may be those with prolonged response to initial therapy and a long interval since initial radiation.

Cited by 71 publications

References 31 publications

Reirradiation in patients with diffuse intrinsic pontine gliomas: The Canadian experience

Reirradiation in patients with diffuse intrinsic pontine gliomas: The Canadian experience

Potential New Therapies for Pediatric Diffuse Intrinsic Pontine Glioma

Re-irradiation for Recurrent Primary Brain Tumors

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