Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma: Results from the Children's Oncology Group Phase 2 Study ACNS0221

Joel M. Cherlow, Dennis W.W. Shaw, Linda R. Margraf, Daniel C Bowers, Jie Huang, Maryam Fouladi, Arzu Onar-Thomas, Tianni Zhou, Ian F. Pollack, Amar Gajjar, Sandy K. Kessel, Patricia L. Cullen, Kevin McMullen, John C. Wellons, Thomas E. Merchant

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 ACNS0221. Methods and Materials: Patients aged 3 to 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 magnetic resonance imaging-based planning and received 54 Gy CRT 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, 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 sex (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 sex (P =.064), non-pilocytic astrocytoma 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.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

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Glioma
radiation therapy
grade
Radiotherapy
Pediatrics
Disease-Free Survival
progressions
margins
Astrocytoma
tumors
histology
Recurrence
chemotherapy
Survival
Histology
Radiation Dosage
Drug Therapy
Neoplasms
Neurofibromatosis 1
entry

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma : Results from the Children's Oncology Group Phase 2 Study ACNS0221. / Cherlow, Joel M.; Shaw, Dennis W.W.; Margraf, Linda R.; Bowers, Daniel C; Huang, Jie; Fouladi, Maryam; Onar-Thomas, Arzu; Zhou, Tianni; Pollack, Ian F.; Gajjar, Amar; Kessel, Sandy K.; Cullen, Patricia L.; McMullen, Kevin; Wellons, John C.; Merchant, Thomas E.

In: International Journal of Radiation Oncology Biology Physics, 01.01.2019.

Research output: Contribution to journalArticle

Cherlow, JM, Shaw, DWW, Margraf, LR, Bowers, DC, Huang, J, Fouladi, M, Onar-Thomas, A, Zhou, T, Pollack, IF, Gajjar, A, Kessel, SK, Cullen, PL, McMullen, K, Wellons, JC & Merchant, TE 2019, 'Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma: Results from the Children's Oncology Group Phase 2 Study ACNS0221', International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2018.11.004
Cherlow, Joel M. ; Shaw, Dennis W.W. ; Margraf, Linda R. ; Bowers, Daniel C ; Huang, Jie ; Fouladi, Maryam ; Onar-Thomas, Arzu ; Zhou, Tianni ; Pollack, Ian F. ; Gajjar, Amar ; Kessel, Sandy K. ; Cullen, Patricia L. ; McMullen, Kevin ; Wellons, John C. ; Merchant, Thomas E. / Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma : Results from the Children's Oncology Group Phase 2 Study ACNS0221. In: International Journal of Radiation Oncology Biology Physics. 2019.
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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 ACNS0221. Methods and Materials: Patients aged 3 to 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 magnetic resonance imaging-based planning and received 54 Gy CRT 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, 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 sex (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 sex (P =.064), non-pilocytic astrocytoma 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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T2 - Results from the Children's Oncology Group Phase 2 Study ACNS0221

AU - Cherlow, Joel M.

AU - Shaw, Dennis W.W.

AU - Margraf, Linda R.

AU - Bowers, Daniel C

AU - Huang, Jie

AU - Fouladi, Maryam

AU - Onar-Thomas, Arzu

AU - Zhou, Tianni

AU - Pollack, Ian F.

AU - Gajjar, Amar

AU - Kessel, Sandy K.

AU - Cullen, Patricia L.

AU - McMullen, Kevin

AU - Wellons, John C.

AU - Merchant, Thomas E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 ACNS0221. Methods and Materials: Patients aged 3 to 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 magnetic resonance imaging-based planning and received 54 Gy CRT 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, 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 sex (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 sex (P =.064), non-pilocytic astrocytoma 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.

AB - 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 ACNS0221. Methods and Materials: Patients aged 3 to 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 magnetic resonance imaging-based planning and received 54 Gy CRT 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, 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 sex (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 sex (P =.064), non-pilocytic astrocytoma 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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