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Hyperfractionated radiotherapy for children with brainstem gliomas: a pilot study using 7,200 cGy
R J Packer1, J C Allen, J L Goldwein
1Children's Hospital of Philadelphia, Division of Neurology, PA 19104.
Annals of Neurology
|February 1, 1990
Summary
High-risk childhood brainstem gliomas show improved outcomes with hyperfractionated radiotherapy. A trial using 7,200 cGy demonstrated a statistically significant increase in progression-free survival compared to lower doses.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-Oncology
Background:
- Brainstem gliomas are aggressive childhood central nervous system tumors, notoriously resistant to therapy.
- High-risk cases, with diffuse involvement or anaplasia, have a poor prognosis despite conventional radiotherapy.
- Hyperfractionated radiotherapy offers a potential strategy to enhance tumor control without increasing toxicity.
Purpose of the Study:
- To evaluate the efficacy and safety of a higher dose of hyperfractionated radiotherapy in high-risk pediatric brainstem gliomas.
- To compare outcomes with historical controls and previous lower-dose hyperfractionation regimens.
Main Methods:
- A multiinstitutional phase I/II trial was conducted for high-risk brainstem glioma patients.
- Treatment involved hyperfractionated radiotherapy at 100 cGy twice daily to a total dose of 7,200 cGy.
- Patient responses, progression-free survival, and toxicity were assessed.
Main Results:
- A 30% actuarial progression-free survival at 20 months was observed.
- Twenty-three of 31 evaluable patients showed an objective radiographic response.
- Statistically significant improvement in progression-free survival was noted compared to historical controls and a 6,480 cGy regimen (p < 0.01).
Conclusions:
- Higher-dose hyperfractionated radiotherapy (7,200 cGy) significantly improves progression-free survival in high-risk pediatric brainstem gliomas.
- The treatment was well-tolerated, with transient side effects and no treatment-related deaths.
- This regimen represents a promising advancement for managing these challenging tumors.
