Reirradiation and Re-reirradiation of Pediatric Midline Gliomas

IF 6.5 1区医学 Q1 ONCOLOGY International Journal of Radiation Oncology Biology Physics Pub Date : 2025-03-01 Epub Date: 2025-02-03 DOI:10.1016/j.ijrobp.2024.11.025

A. Embring , A. Asklid , M. Nilsson , I. Kristensen , M. Blomstrand , C. Fröjd , M. Agrup , A. Flejmer , A. Svärd , J. Engellau

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Abstract

Objectives

Children with midline gliomas have a dismal prognosis and current treatment options cannot offer cure. At progression after primary radiotherapy, reirradiation can be offered to relieve symptoms. The aim of this study is to evaluate the outcome of children treated with reirradiation for midline glioma since implementing national guidelines in 2019.

Methods

All children reirradiated for midline gliomas 2019-2023 in Sweden were retrospectively analysed. A review of medical records and treatment plans was performed to collect data on clinical and treatment characteristics, severe side effects, treatment effect and survival.

Results

Eleven patients were analysed and the median age at start of first reirradiation was 9 years (4-18). The median overall survival from end of first reirradiation was 5.6 months. The median follow-up was 4 months (0-14). The most common (91%) treatment at primary irradiation was 54 Gy in 30 fractions and at first (82%) and second (75%) reirradiation it was 20 Gy in 10 fractions. The median time between first and second irradiation was 8 months (4-27) and 6 months (6-7) between second and third irradiation. The median D2% to the brainstem was 74 Gy (59-91) at first reirradiation (n=11) and 95 Gy (77-95) at second reirradiation (n=4). In patients where the indication for reirradiation was progression of symptoms, 6 patients (67%) had relief of symptoms after reirradiation, and 3 patients (75%) had relief of symptoms after re-reirradiation. No patients had grade ≥3 side effects at reirradiation. One patient had acute respiratory grade ≥3 side effect (hyperventilation) at second reirradiation but recovered after treatment with steroids.

Conclusion

The implementation of national guidelines has harmonised how paediatric midline glioma are treated with reirradiation in Sweden. A structured follow-up shows that severe side effects are rare, and that reirradiation can offer relief of symptoms for selected patients.

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小儿中线胶质瘤的再照射和再照射

目的中线胶质瘤患儿预后不佳，目前的治疗方案无法治愈。初次放疗后病情进展时，可给予再照射以缓解症状。本研究的目的是评估自2019年实施国家指南以来接受中线胶质瘤再照射治疗的儿童的结果。方法回顾性分析2019-2023年瑞典所有因中线胶质瘤再放射治疗的儿童。对医疗记录和治疗计划进行审查，以收集有关临床和治疗特征、严重副作用、治疗效果和生存的数据。结果6例患者首次再照射时的中位年龄为9岁（4 ~ 18岁）。第一次再照射结束后的中位总生存期为5.6个月。中位随访时间为4个月（0-14）。最常见（91%）的第一次放射治疗是54 Gy，分30次，第一次放射治疗（82%）和第二次放射治疗（75%）是20 Gy，分10次。第一次和第二次照射的中位时间为8个月（4-27），第二次和第三次照射的中位时间为6个月（6-7）。第一次再照射（n=11）脑干的中位D2%为74 Gy(59 ~ 91)，第二次再照射（n=4）为95 Gy（77 ~ 95）。在以症状进展为再照射指征的患者中，6例（67%）患者在再照射后症状缓解，3例（75%）患者在再照射后症状缓解。再照射时没有患者出现≥3级副作用。1例患者在第二次再照射时出现急性呼吸级≥3级副作用（过度通气），但在类固醇治疗后恢复。结论：在瑞典，国家指南的实施统一了小儿中线胶质瘤再放射治疗的方法。有组织的随访表明，严重的副作用是罕见的，并且再照射可以缓解选定患者的症状。

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来源期刊

International Journal of Radiation Oncology Biology Physics 医学-核医学

CiteScore

11.00

自引率

7.10%

发文量

2538

审稿时长

6.6 weeks

期刊介绍： International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.