Diffuse brainstem glioma - treated with steroids and RT/temodar like a high grade astrocytoma.
Hyperfractionation has been extensively studied and does not appear to benefit.
Focal brainstem glioma
Tectal glioma treated with CSF diversion and observation.
Tegmental glioma treated with surgical resection.
Dorsal exophytic focal brainstem glioma treated with surgical resection.
Medullary focal brainstem glioma often treated with RT.
Radiation Therapy for Diffuse Brainstem Glioma
Nijmegen, Netherlands; 2009PMID 18990510 -- "The role of hypofractionation radiotherapy for diffuse intrinsic brainstem glioma in children: a pilot study." (Janssens GO, Int J Radiat Oncol Biol Phys. 2009 Mar 1;73(3):722-6. Epub 2008 Nov 5.)
Outcome: Median OS 8.6 months, median TTP 4.9 months; both comparable to "standard" regimens
Toxicity: No Grade 3-4
Conclusion: Radical hypofractionation feasible, offers quick relief with minimal overall treatment time
Harvard; 2003 (1990-96) - PMID 12654425 -- Marcus KJ et al. "A phase I trial of etanidazole and hyperfractionated radiotherapy in children with diffuse brainstem glioma." Int J Radiat Oncol Biol Phys. 2003 Apr 1;55(5):1182-5.
18 pts w/ brainstem glioma tx'd w/ etanidazole + hyperfractionated RT on dose escalation protocol. (66 Gy in 1.5 BID to 1st 3 pts, 63 Gy in 1.5 BID to next 15).
3 grade 3 toxicities (skin, 1 vomiting)
Median survival 8.5 mo
Conclusion: dose limiting toxicity of etanidazole in childhood pt was rash (compared to adults when it is peripheral neurophathy).
POG 9239, 1999 (1992-97) - PMID 10192340 -- Mandell LR et al. "There is no role for hyperfractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brainstem tumors: results of a Pediatric Oncology Group phase III trial comparing conventional vs. hyperfractionated radiotherapy." Int J Radiat Oncol Biol Phys. 1999 Mar 15;43(5):959-64.
130 pts w/ diffuse brainstem glioma tx'd w/ concurrent cisplatin and randomized to hyperfractionated RT (117 cGy BID to 70.2 Gy) vs conventional RT (180 cGy qD to 54 Gy).
OS at 1 yr was 30.9% (conventional) vs 27% (HF); OS at 2 yrs was 7.1% (conventional) vs 6.7% (HF)
Median time to progression was 6 mo's (conventional) vs 5 mo's (HF).
Conclusion: no benefit to hyperfractionated RT for diffuse brainstem glioma.
Egypt, 2012 (2007-11) - Abstract 2012 -- Zaghloul M et al. "Hypofractionated radiotherapy for pediatric diffuse intrinsic pontine glioma (DIPG): A prospective controlled randomized trial" Neuro Oncol (2012) 14 (suppl 1): i26-i32.