Prospective Evaluation of Radiotherapy With Concurrent and Adjuvant Temozolomide in Children With Newly Diagnosed Diffuse Intrinsic Pontine Glioma

Jalali, Rakesh; Raut, Nirmal Vivek; Arora, Brijesh; Gupta, Tejpal; Dutta, Debnarayan; Munshi, Anusheel; Sarin, Rajiv; Kurkure, Purna

doi:10.1016/j.ijrobp.2009.04.031

Cited by 104 publications

(47 citation statements)

References 23 publications

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“…Non-hematological toxicity was also found, negatively affecting their quality of life. Jalali et al [22] also found a toxicity profile similar to ours, with mostly grades III/IV thrombocytopenia and leucopoenia but also grade III/IV vomiting and transient grade II skin toxicity in the irradiated fields. In a multiinstitutional study of TMZ after radiotherapy for patients with newly diagnosed DIPG, Bronicser et al [30] reported a TMZ dose reduction in 42% of their patients, due to prolonged grade III/IV myelosupression.…”

Section: Discussionsupporting

confidence: 87%

“…The survival of children with pseudoprogression was not statistically different from those who had not. No pseudoprogression was reported in the other studies with concurrent radiation therapy and TMZ [22,23].…”

Section: Discussionmentioning

confidence: 72%

“…Therefore, the addition of TMZ to radiotherapy did not show any clear benefit in children with DIPG, in contrast to what has been found in adult glioblastomas. In Jalali's study [22], 20 children with newly diagnosed DIPG were treated with radiotherapy with concurrent and adjuvant TMZ and the median progression-free survival and overall survival were 6. 9 and 9.15 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma

et al. 2011

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The purpose of this study is to evaluate the efficacy and toxicity of radiation therapy (RT) with concurrent temozolomide (TMZ) chemotherapy followed by adjuvant TMZ in children with diffuse intrinsic pontine glioma (DIPG). Newly diagnosed patients younger than 18 years with histologically proven DIPG were treated with focal radiotherapy to a dose of 54 Gy in 30 fractions along with concurrent daily TMZ (75 mg/m(2)/day). Four weeks after completing the initial RT-TMZ schedule, adjuvant TMZ (200 mg/m(2)/day, days 1-5) was given every 28 days up to six cycles. Responses/progressions were assessed by clinical and 2-monthly MRI follow-up studies. Between September 2005 and September 2009, 21 patients with newly diagnosed histologically confirmed DIPG were eligible for this study. Median age at diagnosis was 6.4 years (range 4-16 years). At last update in August 2010, 17 children have died, 1 child was alive with progressive disease and 3 with stable disease. Metastatic relapse was documented in the cerebral site in two patients and in spinal cord in two cases. The median time to progression was 7.5 months (range 28 days-14.5 months) and the median survival was 11.7 months (range 26 days-17.5 months). The 1-year PFS and the 1-year OS were 33 and 50%, respectively. Five patients presented radiological findings compatible with pseudoprogression during the treatment. Haematological toxicity (Grade III/IV thrombocytopenia and leucopenia) was the most commonly found and led to dose reductions of TMZ in 58% of the patients. TMZ with radiation therapy has not yielded any significant improvement in outcome of children with DIPG and is associated with higher toxicity compared with radiotherapy alone. Novel treatment modalities are needed to improve the outcome of these patients.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma

et al. 2011

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“…Patients in this study were evaluated according to an approved institutional review protocol after formal approval from the institutional ethics committee [13]. The study included 20 children with DIPG treated at a tertiary-care cancer centre between March 2005 and November 2006.…”

Section: Methodsmentioning

confidence: 99%

Can Multiparametric MRI and FDG-PET Predict Outcome in Diffuse Brainstem Glioma? A Report from a Prospective Phase-II Study

et al. 2013

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Purpose: To study the impact of multiparametric MRI and ¹⁸F-FDG-PET on the outcome of children with diffuse intrinsic pontine gliomas (DIPG). Materials and Methods: Imaging data from aphase-II prospective therapeutic study in children with newly diagnosed DIPG were considered for evaluation. They included baseline MRI with contrast enhancement before treatment. Functional imaging included MR spectroscopy, MR perfusion and FDG-PET studies. All patients (n = 20) had baseline MRI and 11 patients had FDG-PET. Response was assessed by MRI and PET 4 weeks after therapy. Baseline imaging findings were correlated with survival. Presence or absence of adverse parameters on MRI (heterogeneous contrast enhancement, hyperperfusion or increased choline:NAA ratio) was used to develop a cumulative radiological prognostic index (RPI). Sensitivity and specificity of each imaging modality in tumour grading was estimated. Results: The cumulative RPI was able to classify the patients into different grades and was predictive of overall survival (p = 0.02). MR perfusion also predicted survival (p = 0.039). Sensitivity and specificity of MRI and FDG-PET to detect low-grade gliomas were low to moderate (33-66%), but moderate to high in detecting high-grade gliomas (50-100%). Baseline FDG uptake on PET scan did not correlate with survival (p = 0.7). Conclusions: Cumulative RPI was able to classify tumours into different grades and predicted clinical outcome. At baseline, MR hyperperfusion indicated a shorter survival for DIPG patients. Sensitivity and specificity of imaging modalities to detect low-grade gliomas were poor.

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“…Neither hyper fractionated radiotherapy nor chemotherapy has been shown to add benefit [34]. Following the success of temozolomide in adult high-grade gliomas, similar schedule has been attempted in these patients but without any significant gain in outcome [35]. Low-grade lesions are treated with similar irradiation doses but overall respond less favorably than their counterparts in other locations [36,37].…”

Section: Gliomasmentioning

confidence: 99%

Management of Childhood Brain Tumors: Consensus Report by the Pediatric Hematology Oncology (PHO) Chapter of Indian Academy of Pediatrics (IAP)

et al. 2011

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Brain tumors are the second most common childhood tumors and remain the leading cause of cancer related deaths in children. Appropriate diagnosis and management of these tumors are essential to improve survival. There are no clinical practical guidelines available for the management of brain tumors in India. This document is a consensus report prepared after a National Consultation on Pediatric Brain Tumors held in Delhi on 06 Nov 2008. The meeting was attended by eminent experts from all over the country, in the fields of Neurosurgery, Radiation Oncology, Pediatric Oncology, Neuropathology, Diagnostic Imaging, Pediatric Endocrinology and Allied Health Professionals. This article highlights that physicians looking after children with brain tumors should work as part of a multidisciplinary team to improve the survival, quality of life, neuro-cognitive outcomes and standards of care for children with brain tumors. Recommendations for when to suspect, diagnostic workup, initial management, long-term follow up and specific management of individual tumors are outlined.

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Prospective Evaluation of Radiotherapy With Concurrent and Adjuvant Temozolomide in Children With Newly Diagnosed Diffuse Intrinsic Pontine Glioma

Cited by 104 publications

References 23 publications

Radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma

Radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma

Can Multiparametric MRI and FDG-PET Predict Outcome in Diffuse Brainstem Glioma? A Report from a Prospective Phase-II Study

Management of Childhood Brain Tumors: Consensus Report by the Pediatric Hematology Oncology (PHO) Chapter of Indian Academy of Pediatrics (IAP)

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