Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Blood Cancer. 2019 Sep;66(9):e27881. doi: 10.1002/pbc.27881. Epub 2019 Jun 17.
There are very few studies about the role of repeat irradiation (RT2) for children with recurrent supratentorial high-grade glioma (HGG). It was the aim of this study to assess the effectiveness and safety of RT2 in this population.
This was a retrospective cohort study of 40 children age 18 years and under with recurrent supratentorial HGG who had received at least one course of RT. In-field reirradiation volumes included focal or whole brain RT, with doses ranging from 30 to 54 Gy. The primary endpoint was overall survival (OS) from the first day of RT2.
Fourteen patients underwent RT2. The median survival of these patients was 6.5 months. Patients with ≥12 months elapsed time between RT1 and RT2 experienced longer OS than patients who had < 12 months (P = 0.009). There was no difference in OS between patients with or without germline mutations (e.g., Lynch, Li-Fraumeni, or constitutional mismatch-repair deficiency, P = 0.20). Ten patients received RT2 that overlapped with RT1 volumes for locally recurrent disease. Of this group, 80% experienced clinical benefit from in-field RT2, defined as clinical/radiologic response or stable disease. Ninety-three percent completed the prescribed course of RT2, with one patient developing grade 3 radiation necrosis four months after RT2. When compared with 26 patients who were not offered reirradiation, those selected for RT2 had improved median survival from the time of first disease progression (9.4 vs 3.8 months, P = 0.005).
Reirradiation for children with recurrent supratentorial HGG is a safe, effective treatment that provides short-term disease control.
针对复发性幕上高级别胶质瘤（HGG）患儿，重复放疗（RT2）的作用鲜有研究。本研究旨在评估该人群中 RT2 的有效性和安全性。
这是一项对 40 名年龄在 18 岁及以下、接受过至少一次放疗且患有复发性幕上 HGG 的儿童进行的回顾性队列研究。在野内再放疗的范围包括局部或全脑放疗，剂量从 30 到 54Gy 不等。主要终点是从 RT2 第一天开始的总生存期（OS）。
14 名患者接受了 RT2。这些患者的中位生存时间为 6.5 个月。在 RT1 和 RT2 之间有≥12 个月间隔时间的患者比间隔时间<12 个月的患者 OS 更长（P=0.009）。有或没有胚系突变（如 Lynch、Li-Fraumeni 或错配修复缺陷）的患者 OS 无差异（P=0.20）。10 名患者因局部复发病灶接受了与 RT1 重叠的 RT2。该组中有 80%的患者从在野 RT2 中获得了临床获益，定义为临床/影像学反应或疾病稳定。93%的患者完成了规定的 RT2 疗程，1 名患者在 RT2 后 4 个月发生 3 级放射性坏死。与未接受再放疗的 26 名患者相比，选择接受 RT2 的患者从首次疾病进展开始的中位生存时间得到改善（9.4 对 3.8 个月，P=0.005）。
复发性幕上 HGG 患儿的再放疗是一种安全有效的治疗方法，可提供短期疾病控制。
