Reirradiation practices for children with diffuse intrinsic pontine glioma
Reirradiation practices for children with diffuse intrinsic pontine glioma
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DOI：
10.1093/nop/npaa063
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发表时间：
2021-02-01
影响因子：
2.7
通讯作者：
Warren, Katherine E.
中科院分区：
文献类型：
--
作者：
Cacciotti, Chantel;Liu, Kevin X.;Warren, Katherine E.
背景资料。弥漫性桥脑胶质瘤(DIPGs)是导致儿童脑肿瘤死亡的主要原因。目前的护理标准包括局部放射治疗(RT)。尽管大多数患者的临床情况有所改善，但效果是暂时的，中位生存期不到1年。在进展性DIPG中，再次照射的使用和益处已有报道，但缺乏标准化的方法。我们进行了一项调查，以评估北美DIPG的再照射做法。一项包含14个问题的红帽调查被分发给了396名北美医生，他们负责照顾患有中枢神经系统肿瘤的儿童。有效率为35%。参与者包括放射肿瘤学家(63%；85/135)和儿科肿瘤学家/神经肿瘤学家(37%；50/135)。大多数医生(62%)每年治疗1至5名DIPG患者，10%的医生每年治疗10名以上的患者。88%的受访者认为重新照射是一种治疗选择。进展性疾病和临床状况恶化是考虑再次放射治疗的最常见原因。接受调查的大多数人(84%)认为首次放疗后至少6个月再接受放射治疗。剂量不同，中位总剂量为2400cGy1200~6000cGy.分割大小为200cGy100~900cGy.46%的患者考虑同时使用全身用药和再照射，包括靶向用药(37%)、生物制品(36%)或免疫治疗(25%)。一次性再照射是最常见的做法(71%)。虽然绝大多数内科医生认为再次照射是治疗DIPG的一种方法，但总剂量和分割方式各不相同。需要进一步的临床试验来确定进展性DIPG儿童再次照射的最佳放射剂量和分割。
Background. Diffuse intrinsic pontine gliomas (DIPGs) are a leading cause of brain tumor deaths in children. Current standard of care includes focal radiation therapy (RT). Despite clinical improvement in most patients, the effect is temporary and median survival is less than 1 year. The use and benefit of reirradiation have been reported in progressive DIPG, yet standardized approaches are lacking. We conducted a survey to assess reirradiation practices for DIPG in North America.Methods. A 14-question REDCap survey was disseminated to 396 North American physicians who care for children with CNS tumors.Results. The response rate was 35%. Participants included radiation-oncologists (63%; 85/135) and pediatric oncologists/neuro-oncologists (37%; 50/135). Most physicians (62%) treated 1 to 5 DIPG patients per year, with 10% treating more than 10 patients per year. Reirradiation was considered a treatment option by 88% of respondents. Progressive disease and worsening clinical status were the most common reasons to consider reirradiation. The majority (84%) surveyed considered reirradiation a minimum of 6 months following initial RT. Doses varied, with median total dose of 2400 cGy (range, 1200-6000 cGy) and fraction size of 200 cGy (range, 100-900 cGy). Concurrent use of systemic agents with reirradiation was considered in 46%, including targeted agents (37%), biologics (36%), or immunotherapy (25%). One-time reirradiation was the most common practice (71%).Conclusion. Although the vast majority of physicians consider reirradiation as a treatment for DIPG, total doses and fractionation varied. Further clinical trials are needed to determine the optimal radiation dose and fractionation for reirradiation in children with progressive DIPG.