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Updated: Nov 15, 2025
A Protocol for Rapid Post-mortem Cell Culture of Diffuse Intrinsic Pontine Glioma DIPG
Published on: March 7, 2017
Reirradiation practices for children with diffuse intrinsic pontine glioma
Chantel Cacciotti1, Kevin X Liu2, Daphne A Haas-Kogan2
1Dana Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts.
Insights
Reirradiation is considered for pediatric diffuse intrinsic pontine gliomas (DIPGs), but practices vary widely. Further trials are needed to standardize optimal radiation doses and fractionation for this aggressive childhood brain tumor.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-Oncology
Background:
- Diffuse intrinsic pontine gliomas (DIPGs) are a primary cause of pediatric brain tumor mortality.
- Current focal radiation therapy (RT) offers temporary palliation, with median survival under one year.
- Standardized reirradiation protocols for progressive DIPG are lacking.
Purpose of the Study:
- To survey North American physician practices regarding reirradiation for DIPG.
- To identify current approaches, indications, and variations in reirradiation for DIPG.
Main Methods:
- A 14-question REDCap survey was distributed to 396 North American pediatric CNS tumor specialists.
- Response rate was 35%, including radiation oncologists and pediatric oncologists/neuro-oncologists.
Main Results:
- 88% of respondents consider reirradiation for DIPG, primarily for progressive disease.
- Reirradiation doses and fractionation varied significantly among practitioners.
- Concurrent systemic agents were considered in 46% of cases, with one-time reirradiation being most common (71%).
Conclusions:
- While reirradiation is widely considered for DIPG, significant variability exists in its application.
- Optimal radiation dose and fractionation require further investigation through clinical trials.
- Standardized approaches are necessary to improve outcomes for children with progressive DIPG.
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.
