LONG-TERM SURVIVORS OF CHILDHOOD BRAIN-STEM GLIOMAS TREATED WITH HYPERFRACTIONATED RADIOTHERAPY - CLINICAL CHARACTERISTICS AND TREATMENT RELATED TOXICITIES

BACKGROUND. Over the past decade, the principal focus of research in p ediatric brain stem gliomas has been on the use of hyperfractionated r adiotherapy (HRT). The purpose of this study was to evaluate the clini cal characteristics and treatment related toxicities of long term surv ivors of HRT treatment. METHODS. Of the 130 children with brain stem t umors treated with escalating doses of HRT on Pediatric Oncology Group (POG) #8495, there are only 9 long term survivors. Prospectively coll ected data, including flow sheets and all pretreatment and follow-up r adiologic studies, were reviewed for these patients. Additional inform ation was requested from the treating institutions with regard to sequ elae of treatment. RESULTS. Clinical characteristics (including age, s ex, duration of symptoms, and presenting signs) for the nine surviving patients were not different from the total population of patients tre ated on POG #8495. Pretreatment imaging, however, revealed that only f our of the nine patients had typical diffuse intrinsic pontine lesions and, conversely, that at least three of the nine patients had lesions that would now be considered relatively favorable. Complete informati on regarding treatment related toxicity was available for eight patien ts, only one of whom is without sequelae. Seven have schooling difficu lties, two have a seizure disorder, five have hearing loss, and two ha ve required growth hormone replacement. Follow-up imaging findings wer e striking in four of the eight patients because of white matter chang es consistent with leukoencephalopathy (two patients), diffuse microhe morrhages (one patient), and dystrophic calcification (one patient) in the radiation field. CONCLUSIONS. The high frequency of treatment rel ated sequelae in long term survivors of HRT suggests a need for cautio n in the use of HRT, particularly in patients who have brain stem tumo rs with a more favorable prognosis. (C) 1996 American Cancer Society.