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Updated: May 20, 2025
A Protocol for Rapid Post-mortem Cell Culture of Diffuse Intrinsic Pontine Glioma DIPG
Published on: March 7, 2017
Re-irradiation for children with diffuse intrinsic pontine glioma and diffuse midline glioma
Nisha Shariff1, Alejandro S Moreno2, Julie Bennett3
1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Canada; Department of Clinical Oncology, University Malaya Medical Centre, Malaysia.
Insights
Re-irradiation (RT2) significantly improves survival for children with recurrent diffuse intrinsic pontine glioma (DIPG) and diffuse midline glioma (DMG). This treatment also aids neurological recovery, highlighting the need for biomarkers to select optimal candidates for RT2.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-Oncology
Background:
- Diffuse intrinsic pontine glioma (DIPG) and diffuse midline glioma (DMG) are aggressive, incurable pediatric brain tumors.
- Re-irradiation (RT2) is a potential salvage strategy for recurrent DIPG/DMG.
Purpose of the Study:
- To evaluate the efficacy of re-irradiation (RT2) in improving survival for pediatric patients with recurrent DIPG/DMG.
- To identify prognostic factors associated with outcomes after RT2.
Main Methods:
- Retrospective review of 118 children with DIPG/DMG treated with initial radiotherapy (RT1) and subsequent recurrence.
- Comparison of overall survival (OS) between patients who received RT2 and those who did not.
- Analysis of factors including time from RT1 to RT2 and post-RT imaging.
Main Results:
- Patients receiving RT2 demonstrated significantly improved OS (6-month OS 66% vs 22%, p < 0.0001).
- Median OS was 6.9 months with RT2 versus 2.7 months with RT1 only.
- A latent time of over 1 year between RT1 and RT2 correlated with longer OS (median 10.9 months).
- 61% of RT2 patients experienced neurological symptom improvement.
- Younger age, adverse post-RT1 imaging, and absence of RT2 were poor prognostic factors.
Conclusions:
- Re-irradiation (RT2) offers a survival benefit and aids neurological recovery in pediatric recurrent DIPG/DMG.
- Further research is needed to identify biomarkers for better patient selection for RT2.
Background And Purpose:
Diffuse intrinsic pontine glioma (DIPG) and diffuse midline glioma (DMG) are incurable brain malignancies. In this study, we report one of the largest known single-institution cohorts of DIPG/DMG patients undergoing re-irradiation (RT2) to evaluate its effect on survival.
Materials And Methods:
Children aged less than 18 years treated for DIPG/DMG with initial fractionated photon radiotherapy (RT1) and had subsequent recurrence were retrospectively reviewed. Patients treated with or without RT2 were compared. The primary outcomes were overall survival (OS) from time of recurrence after RT1, and from start of RT2 (for the RT2 group).
Results:
A total of 118 children were included, 39 of whom received RT2. Children treated with RT2 had superior OS, with 6-month OS of 66 % vs 22 % in those who did not undergo RT2 (p < 0.0001). Median survivals were 6.9 months for the RT2 group vs 2.7 months for RT1 only. Median time from RT1 to RT2 was 7.7 months; patients with a greater than 1-year latent time between RT1 and RT2 had longer OS from start of RT2 (median 10.9 months vs 5.5 months, p = 0.023). 61 % of those treated with RT2 experienced improvement of neurologic symptoms post-RT2. Multivariate analysis identified younger age, adverse imaging findings on the 4-week post-RT1 reassessment MRI (including pseudoprogression), and the absence of RT2 as poor prognostic factors for OS.
Conclusion:
Re-irradiation was associated with improved survival and neurological recovery in children with recurrent DIPG and DMG. There is a need to identify novel biomarkers to better select patients who respond best to RT2.
