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A Protocol for Rapid Post-mortem Cell Culture of Diffuse Intrinsic Pontine Glioma DIPG
Published on: March 7, 2017
Hypofractionated conformal radiotherapy for pediatric diffuse intrinsic pontine glioma (DIPG): a randomized
Mohamed S Zaghloul1, Eman Eldebawy1, Soha Ahmed1
1Radiation Oncology Department, Children's Cancer Hospital, Egypt (CCHE) and National Cancer Institute, Cairo University, Egypt.
Insights
Hypofractionated radiotherapy for pediatric diffuse intrinsic pontine glioma (DIPG) showed similar survival outcomes to conventional radiotherapy. This approach reduces patient and healthcare burdens, though it did not meet non-inferiority criteria.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-oncology
Background:
- Pediatric diffuse intrinsic pontine glioma (DIPG) has a poor prognosis despite various treatment strategies.
- Optimizing radiotherapy is crucial for improving outcomes in pediatric DIPG.
Purpose of the Study:
- To compare the efficacy and safety of hypofractionated radiotherapy (HF-RT) versus conventional radiotherapy (CF-RT) for pediatric DIPG.
- To evaluate overall survival (OS) and progression-free survival (PFS) between the two radiotherapy fractionation schedules.
Main Methods:
- A randomized trial involving 71 newly diagnosed pediatric DIPG patients.
- Patients were assigned to either hypofractionated (39Gy/13 fractions/2.6 weeks) or conventional (54Gy/30 fractions/6 weeks) radiotherapy arms.
- Outcomes assessed included OS, PFS, and treatment-related side effects.
Main Results:
- Median OS was 7.8 months for HF-RT vs. 9.5 months for CF-RT; 1-year OS was 36.4% vs. 26.2%.
- Median PFS was 6.6 months for HF-RT vs. 7.3 months for CF-RT; 1-year PFS was 22.5% vs. 17.9%.
- No significant difference in immediate or delayed side effects was observed between the groups.
Conclusions:
- Hypofractionated radiotherapy for pediatric DIPG offers a reduced treatment burden for patients and healthcare systems.
- While survival results were comparable, HF-RT did not meet the predefined non-inferiority margin compared to conventional radiotherapy.
- Further research may explore optimized hypofractionation schedules for DIPG treatment.
Background:
The pediatric diffuse intrinsic pontine glioma (DIPG) outcome remains dismal despite multiple therapeutic attempts.
Purpose:
To compare the results of treatment of pediatric diffuse intrinsic pontine glioma (DIPG) using hypofractionated versus conventional radiotherapy.
Patients And Methods:
Seventy-one newly diagnosed DIPG children were randomized into hypofractionated (HF) (39Gy/13 fractions in 2.6weeks) and conventional (CF) arm (54Gy/30 fractions in 6weeks).
Results:
The median and one-year overall survival (OS) was 7.8months and 36.4±8.2% for the hypofractionated arm, and 9.5 and 26.2±7.4% for the conventional arm respectively. The 18-month OS difference was 2.2%. The OS hazard ratio (HR) was 1.14 (95% CI: 0.70-1.89) (p=0.59). The hypofractionated arm had a median and one-year progression-free survival (PFS) of 6.6months and 22.5±7.1%, compared to 7.3 and 17.9±7.1% for the conventional arm. The PFS HR was 1.10 (95% CI: 0.67-1.90) (p=0.71). The 18-month PFS difference was 1.1%. These differences exceed the non-inferiority margin. The immediate and delayed side effects were not different in the 2 arms.
Conclusions:
Hypofractionated radiotherapy offers lesser burden on the patients, their families and the treating departments, with nearly comparable results to conventional fractionation, though not fulfilling the non-inferiority assumption.
