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

Abstract

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 5mm in the Children's Oncology Group trial ACNS0221. Patients aged 3 to 21years with unresectable progressive, recurrent, or residual PLGG were eligible for this study. Patients younger than 10years 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 54Gy CRT in 30 fractions with a 5-mm CTV margin. Of 85 eligible patients (median age, 13.6years) treated between March 2006 and December 2010, 14 were younger than 10years 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 5.15years, 5-year PFS was 71%±6% andOS 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). For patients with PLGG, CRT with a CTV margin of 5mm yields an acceptable PFS and does not lead to a high rate of marginal relapse.