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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.

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Department of Radiation Oncology, Memorial Health Services Long Beach Medical Center Long Beach, CA.
Department of Diagnostic Imaging, Seattle Children's Hospital, Seattle, WA.
Department of Pathology, Cook Children's Medical Center, Ft. Worth, TX.
Department of Hematology/Oncology, UT Southwestern/Simmons Cancer Center, Dallas, TX.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis TN.
Department of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Mathematics, California State University, Long Beach.
Department of Neurosurgery, Children's Hospital of Pittsburgh of UMPC, Pittsburgh, PA.
Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.
Imaging and Radiation Oncology Core Rhode Island, Lincoln, RI.
Rueckert-Hartman College for Health Professions, Regis University, Denver, CO.
Department of Radiation Oncology, Columbus Regional Health, Columbus IN.
Department of Neurosurgery, Vanderbilt University/Ingram Cancer Center, Nashville, TN.
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN. Electronic address:



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.


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.


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).


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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