How ten-years of reirradiation for paediatric high-grade glioma may shed light on first line treatment.

Autor: Massimino, Maura, Vennarini, Sabina, Barretta, Francesco, Colombo, Francesca, Antonelli, Manila, Pollo, Bianca, Pignoli, Emanuele, Pecori, Emilia, Alessandro, Ombretta, Schiavello, Elisabetta, Boschetti, Luna, Podda, Marta, Puma, Nadia, Gattuso, Giovanna, Sironi, Giovanna, Barzanò, Elena, Nigro, Olga, Bergamaschi, Luca, Chiaravalli, Stefano, Luksch, Roberto
Zdroj: Journal of Neuro-Oncology; Sep2022, Vol. 159 Issue 2, p437-445, 9p
Abstrakt: Purpose: Recurrence incidence for paediatric/adolescent high-grade glioma (HGG) exceeds 80%. Reirradiation (reRT) palliates symptoms and delays further progression. Strategies for reRT are scarce: we retrospectively analysed our series to develop rational future approaches. Methods: We re-evaluated MRI + RT plans of 21 relapsed HGG-patients, accrued 2010–2021, aged under 18 years. All underwent surgery and RT + chemotherapy at diagnosis. Pathologic/molecular re-evaluation allowed classification based on WHO 2021 criteria in 20/21 patients. Survival analyses and association with clinical parameters were performed. Results: Relapse after 1st RT was local in 12 (7 marginal), 4 disseminated, 5 local + disseminated. Re-RT obtained 8 SD, 1 PR, 1PsPD, 1 mixed response, 10 PD; neurological signs/symptoms improved in 8. Local reRT was given to 12, followed again by 6 local (2 marginal) and 4 local + disseminated second relapses in 10/12 re-evaluated. The 4 with dissemination had 1 whole brain, 2 craniospinal irradiation (CSI), 1 spine reRT and further relapsed with dissemination and local + dissemination in 3/four assessed. Five local + disseminated tumours had 3 CSI, 1 spine reRT, further progressing locally (2), disseminated (1), n.a. (1). Three had a third RT; three were alive at 19.4, 29, 50.3 months after diagnosis. Median times to progression/survival after re-RT were 3.7 months (0.6–16.2 months)/6.9 months (0.6–17.9 months), improved for longer interval between 1st RT and re-RT (P = 0.017) and for non-PD after reRT (P < 0.001). First marginal relapse showed potential association with dissemination after re-RT (P = 0.081). Conclusions: This is the biggest series of re-RT in paediatric HGG. Considering the dissemination observed at relapse, our results could prompt the investigation of different first RT fields in a randomized trial. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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