Gallitto Matthew, Lazarev Stanislav, Wasserman Isaac, Stafford James M, Wolden Suzanne L, Terezakis Stephanie A, Bindra Ranjit S, Bakst Richard L
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Biochemistry and Molecular Pharmacology, NYU School of Medicine, New York, New York.
Adv Radiat Oncol. 2019 Mar 30;4(3):520-531. doi: 10.1016/j.adro.2019.03.009. eCollection 2019 Jul-Sep.
Diffuse intrinsic pontine glioma (DIPG) is the most aggressive primary pediatric brain tumor, with <10% of children surviving 2 years. Radiation therapy (RT) remains the mainstay of treatment, but there is a great clinical need for improvements and advancements in treatment strategies. The aim of this systematic review was to identify all available studies in which RT was used to treat patients with DIPG.
A literature search for studies published up to March 10, 2018 was conducted using the PubMed database. We identified 384 articles using search items "diffuse intrinsic pontine glioma" and 221 articles using search items "diffuse brainstem glioma radiotherapy." Included studies were prospective and retrospective series that reported outcomes of DIPG treatment with RT.
We identified 49 studies (1286 patients) using upfront conventionally fractionated RT, 5 studies (92 patients) using hypofractionated RT, and 8 studies (348 patients) using hyperfractionated RT. The mean median overall survival (OS) was 12.0 months, 10.2 months, and 7.9 months in patients who received conventional, hyperfractionated, and hypofractionated RT regimens, respectively. Patients undergoing radiosensitizing therapy had a mean median OS of 11.5 months, and patients who did not receive concomitant systemic therapy had an OS of 9.4 months. In patients who received salvage RT, the mean median OS from initial diagnosis was 16.3 months.
As one of the largest systematic reviews examining RT for DIPG, this report may serve as a useful tool to help clinicians choose the most appropriate treatment approach, while also providing a platform for future investigations into the utility of RT and systemic therapy.
弥漫性脑桥内在型神经胶质瘤（DIPG）是最具侵袭性的原发性儿童脑肿瘤，只有不到10%的儿童能存活2年。放射治疗（RT）仍然是主要的治疗方法，但临床上迫切需要改进和推进治疗策略。本系统评价的目的是识别所有使用RT治疗DIPG患者的现有研究。
使用PubMed数据库对截至2018年3月10日发表的研究进行文献检索。我们使用检索词“弥漫性脑桥内在型神经胶质瘤”识别出384篇文章，使用检索词“弥漫性脑干神经胶质瘤放射治疗”识别出221篇文章。纳入的研究为前瞻性和回顾性系列研究，报告了RT治疗DIPG的结果。
我们识别出49项研究（1286例患者）使用 upfront 常规分割RT，5项研究（92例患者）使用超分割RT，8项研究（348例患者）使用加速分割RT。接受常规、加速分割和超分割RT方案的患者的平均总生存期（OS）分别为12.0个月、10.2个月和7.9个月。接受放射增敏治疗的患者的平均总生存期为11.5个月，未接受同步全身治疗的患者的总生存期为9.4个月。在接受挽救性RT的患者中，从初始诊断开始的平均总生存期为16.3个月。
作为研究RT治疗DIPG的最大规模系统评价之一，本报告可作为帮助临床医生选择最合适治疗方法的有用工具，同时也为未来研究RT和全身治疗的效用提供了一个平台。
