Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026
Reirradiation for diffuse intrinsic pontine glioma in an upper middle-income country: does full dose improve outcomes?
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Dassi Natália, Figueiredo Maria Luisa Sucharski, Gamba Francine Tesser, da Costa Marcos Devanir Silva, Dos Santos Torquato Ana Carolina, Rodrigues Jessica Benigno, de Souza Filho Ronaldo Modesto, Cavalheiro Sergio, Dastoli Patricia Alessandra, Silva Frederico Adolfo, Moraes Carlota Vitoria Blassioli, de Toledo Silvia Regina Caminada, Da Silva Nasjla Saba, Chen Michael Jenwei, Cappellano Andrea Maria
Аннотация
PURPOSE: Reirradiation (reRT) during diffuse intrinsic pontine glioma (DIPG) progression has emerged as a potential treatment strategy for prolonging survival.
METHODS: This retrospective, single-center observational study was conducted on children diagnosed with DIPG between 2010 and 2025, and data from 58 were collected. Doses for reRT were as follows: 50-54 Gy (1.8-2.0 Gy daily/fractions) or 39 Gy (3 Gy daily/fractions). Overall survival (OS) was defined as the time from diagnosis to the date of death and reRT OS, reirradiation starting to death. The Kaplan-Meier method and log-rank test were used for survival analysis.
RESULTS: The median age was 7.1 years (range 2.9-16.2 years). Twenty-six patients underwent a biopsy. The H3K27M mutation was the most prevalent in our study, followed by TP53 altered gene. Twenty-two patients underwent reRT at progression. The median time from initial treatment to reRT was 9.9 months (range 6.7 to 20.5 months). Seven of the 22 patients received reRT at a dose of 39 Gy while 14 at doses of 50-54 Gy. The median OS from reRT to death was 5.8 months (range, 0.9-18.3 months). Patients who received reRT had a longer OS compared to those who did not (median OS of 17.9 versus 9.8 months; p = 0.005). Longer time for progression (> 9 months) and dose of reRT > 50 Gy were statistically significantly correlated with better OS. Reirradiation was generally well-tolerated by all patients.
CONCLUSIONS: This study offers molecular insights into this tumor type and presents a therapeutic option with higher nominal doses reRT within a palliative context to prolong survival of these patients.
METHODS: This retrospective, single-center observational study was conducted on children diagnosed with DIPG between 2010 and 2025, and data from 58 were collected. Doses for reRT were as follows: 50-54 Gy (1.8-2.0 Gy daily/fractions) or 39 Gy (3 Gy daily/fractions). Overall survival (OS) was defined as the time from diagnosis to the date of death and reRT OS, reirradiation starting to death. The Kaplan-Meier method and log-rank test were used for survival analysis.
RESULTS: The median age was 7.1 years (range 2.9-16.2 years). Twenty-six patients underwent a biopsy. The H3K27M mutation was the most prevalent in our study, followed by TP53 altered gene. Twenty-two patients underwent reRT at progression. The median time from initial treatment to reRT was 9.9 months (range 6.7 to 20.5 months). Seven of the 22 patients received reRT at a dose of 39 Gy while 14 at doses of 50-54 Gy. The median OS from reRT to death was 5.8 months (range, 0.9-18.3 months). Patients who received reRT had a longer OS compared to those who did not (median OS of 17.9 versus 9.8 months; p = 0.005). Longer time for progression (> 9 months) and dose of reRT > 50 Gy were statistically significantly correlated with better OS. Reirradiation was generally well-tolerated by all patients.
CONCLUSIONS: This study offers molecular insights into this tumor type and presents a therapeutic option with higher nominal doses reRT within a palliative context to prolong survival of these patients.