J. Lewis et al., UKCCSG STUDY OF ACCELERATED RADIOTHERAPY FOR PEDIATRIC BRAIN-STEM GLIOMAS, International journal of radiation oncology, biology, physics, 38(5), 1997, pp. 925-929
Citations number
16
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: Between 1991 and 1994, the United Kingdom Childhood Cancer St
udy Group (UKCCSG) conducted a multicenter study to assess the efficie
ncy and tolerability of accelerated radiotherapy in children with a di
agnosis of poor-prognosis brain stem glioma, Methods and Materials: Pa
tients eligible for study were those aged 3-16 years with tumors arisi
ng in the pens, medulla, or midbrain, not previously treated with radi
otherapy or chemotherapy. Histologic confirmation was not mandatory, b
ut computed tomography or magnetic resonance imaging and clinical find
ings had to be typical, and patients were selected with short prediagn
osis symptom history (< 3 months), cranial nerve palsies or long tract
signs, and intrinsic diffuse lesions on scanning. The treatment dose
was 48.6 Gy in 27 fractions, increased to 50.4 Gy in 28 fractions in J
anuary 1992, delivered twice daily (except weekends) with an interfrac
tion interval of at least 8 h. Between January 1991 and July 1993, 28
available patients were recruited: 15 boys and 13 girls with ages rang
ing between 3 and 13 years (median 6). Results: After treatment, neuro
logic improvement sustained for a period of at least 6 weeks without s
teroids was reported in 13 children (46%). On central review of postra
diotherapy imaging, 50% of children showed evidence of partial respons
e, but none exhibited a complete response. A further six patients (22%
) had stable disease. The median survival time was 37 weeks (8.5 month
s); 1-year survival was 32%, and 2-year survival 11%. The pattern of r
elapse was local in all 26 patients who died of their disease; 1 patie
nt had evidence of leptomeningeal seeding. Acute radiation morbidity w
as minimal, with only three patients (11%) exhibiting mild toxicity. N
o evidence of radiation-induced necrosis was found radiologically or h
istologically at postmortem. Ability to withdraw steroids following ra
diotherapy was the single most important prognostic variable in our st
udy. Conclusion: The results of this study are comparable to previous
outcomes of studies with conventional and hyperfractionated radiothera
py in poor-prognosis brain stem glioma. The fractionation regimen was
shown to be tolerable with an acceptable morbidity profile. However, f
urther research is required to improve the poor prognosis of these unf
ortunate children. (C) 1997 Elsevier Science Inc.