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Int J Radiat Oncol Biol Phys. 2018 Nov 9. pii: S0360-3016(18)33951-8. doi: 10.1016/j.ijrobp.2018.11.004. [Epub ahead of print]

Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma: Results from the Children's Oncology Group Phase II Study XXXX.

Author information

1
Department of Radiation Oncology, Memorial Health Services Long Beach Medical Center Long Beach, CA.
2
Department of Diagnostic Imaging, Seattle Children's Hospital, Seattle, WA.
3
Department of Pathology, Cook Children's Medical Center, Ft. Worth, TX.
4
Department of Hematology/Oncology, UT Southwestern/Simmons Cancer Center, Dallas, TX.
5
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis TN.
6
Department of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
7
Department of Mathematics, California State University, Long Beach.
8
Department of Neurosurgery, Children's Hospital of Pittsburgh of UMPC, Pittsburgh, PA.
9
Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.
10
Imaging and Radiation Oncology Core Rhode Island, Lincoln, RI.
11
Rueckert-Hartman College for Health Professions, Regis University, Denver, CO.
12
Department of Radiation Oncology, Columbus Regional Health, Columbus IN.
13
Department of Neurosurgery, Vanderbilt University/Ingram Cancer Center, Nashville, TN.
14
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN. Electronic address: thomas.merchant@stjude.org.

Abstract

PURPOSE:

To determine the rate of marginal relapse, progression-free survival (PFS), and overall survival (OS) in patients with pediatric low-grade glioma (PLGG) treated with conformal radiation therapy (CRT) with a clinical target volume (CTV) margin of 5 mm in the Children's Oncology Group trial XXXX.

METHODS AND MATERIALS:

Children (age 3-21 years) with unresectable progressive, recurrent, or residual PLGG were eligible for this study. Patients younger than 10 years were required to have received at least 1 chemotherapy course. Patients with neurofibromatosis type I were not eligible. All patients underwent MRI-based planning and received CRT 54 Gy in 30 fractions with a 5-mm CTV margin.

RESULTS:

Of 85 eligible patients (median age 13.6 years) treated between March 2006 and December 2010, 14 were younger than 10 years and 36 received prior chemotherapy. Sixty-six had pilocytic astrocytoma (PA); 15 had other histologic subtypes, and 4 had unbiopsied chiasmatic lesions. Events included 23 relapses - 19 central 4 distant, and no marginal - and 7 deaths. At a median follow-up of 5.15 years, 5-year PFS was 71%±6% and OS was 93%±4%. Male gender (P=.068) and large tumor size (P=.050) trended toward significance for association with decreased PFS. Age, histology, tumor location, time between diagnosis and study entry, and MIB-1 status were not associated with PFS. OS was negatively associated with male gender (P=.064), non-PA histology (P=.010), and large tumor size (P=.0089).

CONCLUSIONS:

For patients with PLGG, CRT with a CTV margin of 5 mm yields an acceptable PFS and does not lead to a high rate of marginal relapse.

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