Shariff Nisha, Moreno Alejandro S, Bennett Julie, Ramaswamy Vijay, Das Anirban, Liu Anthony P, Huang Annie, Tabori Uri, Hawkins Cynthia, Dirks Peter, Bouffet Eric, Keilty Dana M, Millar Barbara-Ann, Hodgson David C, Tsang Derek S
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Canada; Department of Clinical Oncology, University Malaya Medical Centre, Malaysia.
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Canada.
Radiother Oncol. 2025 Jun;207:110865. doi: 10.1016/j.radonc.2025.110865. Epub 2025 Mar 24.
Diffuse intrinsic pontine glioma (DIPG) and diffuse midline glioma (DMG) are incurable brain malignancies. In this study, we report one of the largest known single-institution cohorts of DIPG/DMG patients undergoing re-irradiation (RT2) to evaluate its effect on survival.
Children aged less than 18 years treated for DIPG/DMG with initial fractionated photon radiotherapy (RT1) and had subsequent recurrence were retrospectively reviewed. Patients treated with or without RT2 were compared. The primary outcomes were overall survival (OS) from time of recurrence after RT1, and from start of RT2 (for the RT2 group).
A total of 118 children were included, 39 of whom received RT2. Children treated with RT2 had superior OS, with 6-month OS of 66 % vs 22 % in those who did not undergo RT2 (p < 0.0001). Median survivals were 6.9 months for the RT2 group vs 2.7 months for RT1 only. Median time from RT1 to RT2 was 7.7 months; patients with a greater than 1-year latent time between RT1 and RT2 had longer OS from start of RT2 (median 10.9 months vs 5.5 months, p = 0.023). 61 % of those treated with RT2 experienced improvement of neurologic symptoms post-RT2. Multivariate analysis identified younger age, adverse imaging findings on the 4-week post-RT1 reassessment MRI (including pseudoprogression), and the absence of RT2 as poor prognostic factors for OS.
Re-irradiation was associated with improved survival and neurological recovery in children with recurrent DIPG and DMG. There is a need to identify novel biomarkers to better select patients who respond best to RT2.
弥漫性脑桥内在型胶质瘤（DIPG）和弥漫性中线胶质瘤（DMG）是无法治愈的脑恶性肿瘤。在本研究中，我们报告了已知最大的单机构接受再照射（RT2）的DIPG/DMG患者队列之一，以评估其对生存的影响。
对年龄小于18岁、接受过初始分次光子放疗（RT1）治疗DIPG/DMG且随后复发的儿童进行回顾性研究。比较接受或未接受RT2治疗的患者。主要结局指标为RT1后复发时间的总生存期（OS），以及RT2开始后的总生存期（RT2组）。
共纳入118名儿童，其中39名接受了RT2。接受RT2治疗的儿童总生存期更长，RT2组6个月总生存率为66%，未接受RT2治疗的儿童为22%（p<0.0001）。RT2组的中位生存期为6.9个月，仅接受RT1组为2.7个月。从RT1到RT2的中位时间为7.7个月；RT1和RT2之间潜伏时间大于1年的患者从RT2开始的总生存期更长（中位10.9个月对5.5个月，p=0.023）。61%接受RT2治疗的患者在RT2后神经症状有所改善。多因素分析确定年龄较小、RT1后4周重新评估MRI的不良影像学表现（包括假性进展）以及未接受RT2是总生存期的不良预后因素。
再照射与复发性DIPG和DMG儿童的生存改善及神经功能恢复相关。需要识别新的生物标志物，以更好地选择对RT2反应最佳的患者。
