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Reirradiation in Patients with Diffuse Intrinsic Pontine Gliomas: The Canadian experience
Pediatric Blood & Cancer
  • Alvaro Lassaletta, The Hospital for Sick Children
  • Douglas Strother, Cumming School of Medicine
  • Normand Laperriere, Princess Margaret Cancer Centre
  • Juliette Hukin, British Columbia Children's Hospital
  • Magimairajan Issai Vanan, Cancer Care Manitoba
  • Karen Goddard, British Columbia Children's Hospital
  • Lucie Lafay-Cousin, University of Calgary
  • Donna L Johnston, Children's Hospital of Eastern Ontario
  • Shayna Zelcer, Western University
  • Michal Zapotocky, The Hospital for Sick Children
  • Revathi Rajagopal, The Hospital for Sick Children
  • Vijay Ramaswamy, The Hospital for Sick Children
  • Cynthia Hawkins, The Hospital for Sick Children
  • Uri Tabori, The Hospital for Sick Children
  • Annie Huang, The Hospital for Sick Children
  • Ute Bartels, The Hospital for Sick Children
  • Eric Bouffet, The Hospital for Sick Children
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OBJECTIVE: Clinical trials have failed to demonstrate a survival benefit of adjuvant chemotherapy in diffuse intrinsic pontine gliomas (DIPG). Radiation therapy (RT) is the only effective treatment thus far and reirradiation (rRT) has become an option at the time of progression. The aim of this study was to review the Canadian experience of DIPG rRT with a focus on the safety and possible efficacy of this approach.

METHOD: We retrospectively reviewed the demographic, clinical, and RT data of patients with DIPG treated in Canada with rRT.

RESULTS: Since January 2011, we identified 16 patients with progressive DIPG who received rRT. Median time from diagnosis to progression was 10.5 months (range, 4-37 months). rRT was given focally in 14 patients at a dose ranging from 21.6 to 36 Gy. rRT was well tolerated by all children but one. All but three patients showed neurological improvement. With a median follow-up from original diagnosis of 19.2 months, all patients died, with a median time from rRT to death of 6.48 months (range, 3.83-13.26 months). When compared to a historic cohort of 46 consecutive patients, the median time from progression to death was 92 days in the non-reirradiated patients versus 218 days in the reirradiated ones (P = 0.0001).

CONCLUSION: In this limited experience, rRT was safe and feasible in patients with progressive DIPG, providing neurological improvement and a prolonged life span in most patients. Prospective Canadian rRT protocols are ongoing to further assess the benefit of this approach, including quality of life assessment.

Citation Information
Alvaro Lassaletta, Douglas Strother, Normand Laperriere, Juliette Hukin, et al.. "Reirradiation in Patients with Diffuse Intrinsic Pontine Gliomas: The Canadian experience" Pediatric Blood & Cancer Vol. 65 Iss. 6 (2018)
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