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09-07-2022 | Glioma | Case Study

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

Authors: Maura Massimino, Sabina Vennarini, Francesco Barretta, Francesca Colombo, Manila Antonelli, Bianca Pollo, Emanuele Pignoli, Emilia Pecori, Ombretta Alessandro, Elisabetta Schiavello, Luna Boschetti, Marta Podda, Nadia Puma, Giovanna Gattuso, Giovanna Sironi, Elena Barzanò, Olga Nigro, Luca Bergamaschi, Stefano Chiaravalli, Roberto Luksch, Cristina Meazza, Filippo Spreafico, Monica Terenziani, Michela Casanova, Andrea Ferrari, Marco Chisari, Chiara Pellegrini, Carlo Alfredo Clerici, Piergiorgio Modena, Veronica Biassoni

Published in: Journal of Neuro-Oncology | Issue 2/2022

Abstract

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.

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Title: How ten-years of reirradiation for paediatric high-grade glioma may shed light on first line treatment
Authors: Maura Massimino
Sabina Vennarini
Francesco Barretta
Francesca Colombo
Manila Antonelli
Bianca Pollo
Emanuele Pignoli
Emilia Pecori
Ombretta Alessandro
Elisabetta Schiavello
Luna Boschetti
Marta Podda
Nadia Puma
Giovanna Gattuso
Giovanna Sironi
Elena Barzanò
Olga Nigro
Luca Bergamaschi
Stefano Chiaravalli
Roberto Luksch
Cristina Meazza
Filippo Spreafico
Monica Terenziani
Michela Casanova
Andrea Ferrari
Marco Chisari
Chiara Pellegrini
Carlo Alfredo Clerici
Piergiorgio Modena
Veronica Biassoni
Publication date: 09-07-2022
Publisher: Springer US
Keywords: Glioma
Glioma
Glioma
Published in: Journal of Neuro-Oncology / Issue 2/2022
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-022-04079-4

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

Abstract

Purpose

Methods

Results

Conclusions

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