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Proton therapy for newly diagnosed pediatric diffuse intrinsic pontine glioma

Abstract

Introduction

Diffuse intrinsic pontine glioma (DIPG) is a type of brain malignancy with a very poor prognosis. Although various radiation and chemotherapy protocols have been attempted, only conventional radiotherapy has yielded improvements in survival. In this study, we aimed to compare proton therapy versus conventional photon radiotherapy in terms of the outcomes of pediatric patients with DIPG.

Methods

This retrospective review included 12 pediatric patients with newly diagnosed DIPG who received a total proton therapy dose of 54 Gy (relative biological effectiveness) in 30 fractions at the University of Tsukuba Hospital between 2011 and 2017 (proton group). We additionally reviewed the medical records of 10 patients with DIPG who previously underwent conventional photon radiotherapy at our institute (historical cohort).

Results

The median progression-free survival (PFS) duration was 5 months (range 1–11 months), and the 6-, 12-, and 18-month PFS rates were 50%, 33%, and 25%, respectively. The median overall survival (OS) duration was 9 months (range 4–48 months), and the 6-, 12-, 18-, and 24-month OS rates were 66.8%, 50%, 41%, and 20%, respectively. There were no significant differences in survival between the proton and historical groups (PFS, p = 0.169 and OS, p = 0.16).

Conclusions

Proton therapy was well tolerated by the majority of patients. No severe adverse events, including radiation necrosis, were recorded. Proton therapy did not yield superior survival outcomes vs. conventional photon radiotherapy in patients with DIPG at our institution. Further research is needed to identify the factors associated with better survival in this population.

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Acknowledgments

We would like to thank Editage (www.editage.com) for the English language editing.

Author information

All authors contributed to the study conception and design. Material preparation and data collection were performed by AM, MM, TT, HF, and SI. The first draft of the manuscript was written by AM, MM, and EI and all authors commented on previous versions of the manuscript. HS, and AMa critically supervised the manuscript. All authors read and approved the final manuscript.

Correspondence to Ai Muroi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of the University of Tsukuba Hospital.

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Cite this article

Muroi, A., Mizumoto, M., Ishikawa, E. et al. Proton therapy for newly diagnosed pediatric diffuse intrinsic pontine glioma. Childs Nerv Syst (2019) doi:10.1007/s00381-019-04420-9

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Keywords

  • Proton therapy
  • Diffuse intrinsic pontine glioma
  • Radiotherapy
  • Reirradiation