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Reirradiation for diffuse intrinsic pontine glioma: a systematic review and meta-analysis

  • Victor M. LuEmail author
  • John P. Welby
  • Anita Mahajan
  • Nadia N. Laack
  • David J. DanielsEmail author
Review Article

Abstract

Background

Diffuse intrinsic pontine glioma (DIPG) is a pediatric brain tumor with dismal prognosis despite initial radiation therapy (RT). The clinical consequences of attempting reirradiation (reRT) in these patients to alleviate both symptomatology and improve prognosis are currently unclear. Thus, the aim of this systematic review and meta-analysis was to clarify the efficacy and safety of reRT in DIPG.

Methods

Searches of seven electronic databases from inception to January 2019 were conducted following the appropriate guidelines. Articles were screened against prespecified criteria. The incidence and duration of clinical outcomes were then extracted and pooled by means of meta-analysis from the included studies.

Results

A total of 7 studies satisfied all criteria, describing 90 cases of DIPG in which reRT was attempted 11.8–14 months after initial RT. Based on a random-effects model, the incidences of clinical improvement and radiologic response following reRT were 87% (95% CI, 78–95%) and 69% (95% CI, 52–84%), respectively. The incidence of acute serious toxicity was 0% (95% CI, 0–4%). Pooled overall survivals from initial diagnosis and time of reRT were 18.0 months (95% CI, 14.2–21.7) and 6.2 months (95% CI, 5.5–7.0), respectively.

Conclusions

Based on these results, the clinical consequences of reRT for DIPG when administered appropriately and safely at first progression appear acceptable, and potentially favorable, based on the limited evidence in the current literature. Concerns regarding acute serious toxicity were not realized. It is likely that a subcohort of all DIPG diagnoses will be most amenable to improve prognosis with reRT, and greater investigation is required to identify their characteristics.

Keywords

Diffuse intrinsic pontine glioma Reirradiation Radiation therapy Pediatric Neuro-oncology 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no funding sources or conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Supplementary material

381_2019_4118_MOESM1_ESM.docx (876 kb)
ESM 1 (DOCX 875 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryMayo ClinicRochesterUSA
  2. 2.Department of Radiation OncologyMayo ClinicRochesterUSA

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