Phase II Trial of Conformal Radiation Therapy for Pediatric Low-Grade Glioma

The use of radiotherapy in pediatric low-grade glioma (LGG) is controversial, especially for young patients. We conducted a phase II trial of conformal radiation therapy (CRT) to estimate disease control by using a 10-mm clinical target volume (CTV) margin. Between August 1997 and August 2006, 78 pe...

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Bibliographic Details
Published in:	Journal of clinical oncology Vol. 27; no. 22; pp. 3598 - 3604
Main Authors:	MERCHANT, Thomas E, KUN, Larry E, SHENGJIE WU, XIAOPINGXIONG, SANFORD, Robert A, BOOP, Frederick A
Format:	Journal Article
Language:	English
Published:	Alexandria, VA American Society of Clinical Oncology 01-08-2009
Subjects:	Adolescent Age Factors Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biological and medical sciences Biopsy, Needle Brain Neoplasms - drug therapy Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - radiotherapy Child Child, Preschool Combined Modality Therapy Disease-Free Survival Dose-Response Relationship, Radiation Female Glioma - drug therapy Glioma - mortality Glioma - pathology Glioma - radiotherapy Humans Immunohistochemistry Kaplan-Meier Estimate Magnetic Resonance Angiography Male Medical sciences Neoplasm Invasiveness - pathology Neoplasm Staging Neurology Original Reports Prognosis Prospective Studies Radiotherapy Dosage Radiotherapy, Conformal - adverse effects Radiotherapy, Conformal - methods Risk Assessment Statistics, Nonparametric Survival Analysis Treatment Outcome Tumors Tumors of the nervous system. Phacomatoses Young Adult Human Pediatrics Conformal radiotherapy Nervous system diseases Cancerology Glioma Central nervous system disease Phase II trial Tumor Child Low grade
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Summary:	The use of radiotherapy in pediatric low-grade glioma (LGG) is controversial, especially for young patients. We conducted a phase II trial of conformal radiation therapy (CRT) to estimate disease control by using a 10-mm clinical target volume (CTV) margin. Between August 1997 and August 2006, 78 pediatric patients with LGG and a median age of 8.9 years (range, 2.2 to 19.8 years) received 54 Gy CRT by using a 10-mm CTV and by targeting with systematic magnetic resonance imaging (MRI) registration. Tumor locations were diencephalon (n = 58), cerebral hemisphere (n = 3), and cerebellum (n = 17). Sixty-seven patients had documented or presumed WHO grade 1 tumors, 25 patients had prior chemotherapy, and 13 patients had neurofibromatosis type 1. During a median follow-up of 89 months, 13 patients experienced disease progression. One patient experienced marginal treatment failure, eight experienced local failures, and four experienced metastatic failure. The mean and standard error 5- and 10-year event-free (87.4% +/- 4.4% and 74.3% +/- 15.4%, respectively) and overall (98.5% +/- 1.6% and 95.9% +/- 5.8%, respectively) survival rates were determined. The mean and standard error cumulative incidences of local failure at 5 and 10 years were 8.7% +/- 3.5% and 16.4% +/- 5.4%, respectively. The mean and standard error cumulative incidence of vasculopathy was 4.79% +/- 2.73% at 6 years, and it was higher for those younger than 5 years of age (P = .0105) at the time of CRT. This large, prospective series of irradiated children with LGG demonstrates that CRT with a 10-mm CTV does not compromise disease control. The results suggest that CRT should be delayed in young patients to reduce the risk of vasculopathy.
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.2008.20.9494