Massimino Maura, Vennarini Sabina, Barretta Francesco, Colombo Francesca, Antonelli Manila, Pollo Bianca, Pignoli Emanuele, Pecori Emilia, Alessandro Ombretta, Schiavello Elisabetta, Boschetti Luna, Podda Marta, Puma Nadia, Gattuso Giovanna, Sironi Giovanna, Barzanò Elena, Nigro Olga, Bergamaschi Luca, Chiaravalli Stefano, Luksch Roberto, Meazza Cristina, Spreafico Filippo, Terenziani Monica, Casanova Michela, Ferrari Andrea, Chisari Marco, Pellegrini Chiara, Clerici Carlo Alfredo, Modena Piergiorgio, Biassoni Veronica
Pediatrics (MM, LB, VB, ES, CAC), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
Pediatric Radiotherapy (SV, FC, EP, OA), Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
J Neurooncol. 2022 Sep;159(2):437-445. doi: 10.1007/s11060-022-04079-4. Epub 2022 Jul 9.
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.
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.
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).
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.
小儿/青少年高级别胶质瘤（HGG）的复发率超过80%。再程放疗（reRT）可缓解症状并延缓疾病进一步进展。再程放疗的策略较少：我们对本系列病例进行回顾性分析，以制定合理的未来治疗方案。
我们重新评估了2010年至2021年期间收治的21例复发HGG患儿（年龄小于18岁）的MRI及放疗计划。所有患儿在诊断时均接受了手术及放化疗。根据2021年世界卫生组织标准，对20/21例患者进行了病理/分子重新评估并分类。进行了生存分析以及与临床参数的相关性分析。
首次放疗后复发的情况为：12例为局部复发（7例为边缘复发），4例为播散性复发，5例为局部复发合并播散性复发。再程放疗后，8例达到疾病稳定（SD），1例部分缓解（PR），1例疾病稳定伴部分进展（PsPD），1例为混合反应，10例疾病进展（PD）；8例患者的神经体征/症状得到改善。12例患者接受了局部再程放疗，其中10/12例患者再次出现6例局部复发（2例为边缘复发）和4例局部复发合并播散性复发。4例播散性复发患者中，1例接受了全脑放疗，2例接受了全脑脊髓放疗（CSI），1例接受了脊柱再程放疗，在评估的4例患者中，3例进一步出现播散性复发以及局部复发合并播散性复发。5例局部复发合并播散性肿瘤患者中，3例接受了CSI，1例接受了脊柱再程放疗，进一步出现局部进展（2例）、播散性进展（1例）、未评估（1例）。3例患者接受了第三次放疗；3例患者在诊断后19.4、29、50.3个月时仍存活。再程放疗后的中位进展时间/生存时间分别为3.7个月（0.6 - 16.2个月）/6.9个月（0.6 - 17.9个月），首次放疗与再程放疗间隔时间较长者以及再程放疗后未出现疾病进展者的生存时间有所改善（P = 0.017；P < 0.001）。首次边缘复发显示与再程放疗后的播散性复发可能相关（P = 0.081）。
这是小儿HGG再程放疗最大的系列病例。考虑到复发时观察到的播散情况，我们的结果可能促使在随机试验中研究不同的首次放疗范围。
