Østergaard D E, Embring A, Sehested A, Magelssen H, Vogelius I R, Kjærsgaard M, Nysom K, Mathiasen R, Lukacova S, Maraldo M V
Section of Radiotherapy, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
Department of Oncology, Karolinska University Hospital, Sweden; Department of Oncology-Pathology, Karolinska Institute, Sweden.
Clin Oncol (R Coll Radiol). 2025 Jan;37:103682. doi: 10.1016/j.clon.2024.103682. Epub 2024 Nov 6.
Diffuse midline glioma (DMG) continues to be an aggressive brain stem cancer among children and young adults. It has a dismal prognosis, with less than 10% of patients alive two years after diagnosis. Radiotherapy has been demonstrated to be effective, albeit transient. Hence, radiotherapy is considered a cornerstone in the treatment. Reirradiation has, in retrospective studies, shown promising overall survival and palliative effect, but no pan-European consensus for reirradiation exists. The REMIT (Reirradiation of diffuse Midline glioma paTients) protocol evaluates safety and the palliative efficacy of reirradiation of patients with DMG (clinicaltrials.gov NCT06093165). Patients included in the protocol will be followed with 1) performance status (Karnofsky or Lansky), 2) toxicity monitored with Common Terminology Criteria for Adverse Events (CTCAE), 3) motor and functioning skill with PEDI-CAT (The Pediatric Evaluation of Disability Inventory) and 4) quantification of corticosteroid use. Furthermore, the impact on quality of life and well-being will be assessed qualitatively with interviews as well as with the Pediatric Quality of Life Inventory (PedsQl) Cancer Module questionnaire. The protocol also includes dose accumulation and contouring studies to assess standardization as well as a prescreening log to address selection bias of patients. The safety and palliative efficacy of reirradiation in DMG will be prospectively evaluated, including qualitative patient reported outcomes, through the REMIT protocol. REMIT is planned to open for inclusion in 2024.
弥漫性中线胶质瘤（DMG）在儿童和年轻成年人中仍然是一种侵袭性的脑干癌。其预后很差，诊断后两年存活的患者不到10%。放疗已被证明是有效的，尽管是短暂的。因此，放疗被认为是治疗的基石。回顾性研究表明，再程放疗在总生存期和姑息治疗效果方面前景良好，但欧洲对于再程放疗尚无统一共识。REMIT（弥漫性中线胶质瘤患者再程放疗）方案评估DMG患者再程放疗的安全性和姑息治疗效果（临床试验.gov NCT06093165）。该方案纳入的患者将接受以下随访：1） 体能状态（卡诺夫斯基或兰斯基评分），2） 用不良事件通用术语标准（CTCAE）监测毒性，3） 用儿童残疾评定量表（PEDI-CAT）评估运动和功能技能，4） 量化皮质类固醇的使用情况。此外，将通过访谈以及儿童生活质量量表（PedsQl）癌症模块问卷对生活质量和幸福感的影响进行定性评估。该方案还包括剂量累积和轮廓研究以评估标准化情况，以及一个预筛查日志以解决患者选择偏倚问题。将通过REMIT方案前瞻性评估DMG患者再程放疗的安全性和姑息治疗效果，包括患者报告的定性结果。REMIT计划于2024年开始纳入患者。
