TY - JOUR
T1 - Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma
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.
N1 - Funding Information:
This clinical trial was supported by Children's Oncology Group (COG) Group Operations U10 CA098543, COG Statistics and Data Center U10 CA098413, COG Group Operations U10 CA180886, COG Statistics and Data Center U10 CA180899, and Quality Assurance Review Center (QARC) U10 29511 and Imaging and Radiation Oncology Core Rhode Island (IROC RI) U24 CA180803.Conflict of interest: J.C., J.H., and L.M. report grants from the National Cancer Institute to Children's Oncology Group, CureSearch, Quality Assurance Review Center, and/or IROC Imaging and Radiation Oncology Core during the conduct of the study. K.M. reports medical direction for cancer pathways for lymphoma and ownership of SINK Cancer, a medical physics and dosimetry staffing company, outside the submitted work.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/3/15
Y1 - 2019/3/15
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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U2 - 10.1016/j.ijrobp.2018.11.004
DO - 10.1016/j.ijrobp.2018.11.004
M3 - Article
C2 - 30419305
AN - SCOPUS:85059945748
SN - 0360-3016
VL - 103
SP - 861
EP - 868
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 4
ER -