Cancer Res Treat.  2023 Jan;55(1):41-49. 10.4143/crt.2021.1514.

Suggestions for Escaping the Dark Ages for Pediatric Diffuse Intrinsic Pontine Glioma Treated with Radiotherapy: Analysis of Prognostic Factors from the National Multicenter Study

• Kim HJ
• Lee JH
• Kim Y
• Lim DH
• Park SH
• Ahn SD
• Kim IA
• Im JH
• Chung JW
• Kim JY
• Kim IH
• Yoon HI
• Suh CO

• KMID: 2537990
• DOI: http://doi.org/10.4143/crt.2021.1514

Abstract

Purpose
This multicenter retrospective study aimed to investigate clinical, radiologic, and treatment-related factors affecting survival in patients with newly diagnosed diffuse intrinsic pontine glioma (DIPG) treated with radiotherapy.
Materials and Methods
Patients aged <30 years who underwent radiotherapy as an initial treatment for DIPG between 2000 and 2018 were included; patients who did not undergo magnetic resonance imaging at diagnosis and those with pathologically diagnosed grade I glioma were excluded. We examined medical records of 162 patients collected from 10 participating centers in Korea. The patients’ clinical, radiological, molecular, and histopathologic characteristics, and treatment responses were evaluated to identify the prognosticators for DIPG and estimate survival outcomes.
Results
The median follow-up period was 10.8 months (interquartile range, 7.5 to 18.1). The 1- and 2-year overall survival (OS) rates were 53.5% and 19.0%, respectively, with a median OS of 13.1 months. Long-term survival rate (≥ 2 years) was 16.7%, and median OS was 43.6 months. Age (< 10 years), poor performance status, treatment before 2010, and post-radiotherapy necrosis were independently associated with poor OS in multivariate analysis. In patients with increased post-radiotherapy necrosis, the median OS estimates were 13.3 months and 11.4 months with and without bevacizumab, respectively (p=0.138).
Conclusion
Therapeutic strategy for DIPG has remained unchanged over time, and the associated prognosis remains poor. Our findings suggest that appropriate efforts are needed to reduce the occurrence of post-radiotherapy necrosis. Further well-designed clinical trials are recommended to improve the poor prognosis observed in DIPG patients.

Keyword

Diffuse intrinsic pontine glioma; Radiotherapy; Prognosis

Figure

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  Fig. 1 Kaplan-Meier curves representing overall survival rates based on patient age (years) (A), performance status (B), treatment period (C), and post-radiotherapy necrosis (D). KPS, Karnofsky performance status.

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  Fig. 2 Overall survival rates according to the use of bevacizumab in the increased post-radiotherapy necrosis (A) and no post-radiotherapy necrosis/decreased groups (B).

Reference

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