{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:27:27Z","timestamp":1792013247155,"version":"4.4.0"},"reference-count":10,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children with recurrent diffuse midline gliomas (DMGs) have limited therapeutic options at recurrence. Re\u2010irradiation (RT2) may be used at progression, but with uncertainty about the benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multi\u2010institutional retrospective study of children aged &lt; 18 with DMG treated at three centers (Toronto, Canada; Birmingham, UK; Nottingham, UK). Patients with radiologic progression after the first radiation (RT1) were included. Overall survival (OS) was calculated from the date of progression after RT1. Survival was analyzed using the Kaplan\u2013Meier method. Multivariable Cox regression identified independent predictors of OS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 167 patients were included with a median age of 7.9 years; 54 (32%) received RT2. Children selected for RT2 had a longer interval from RT1 to progression (0.79 vs. 0.52 years,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0001). Median OS from progression was longer in the RT2 group (0.59 years) compared to the no RT2 cohort (0.21 years;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0001). Six\u2010month OS was 68% versus 16%, and 1\u2010year OS was 19% versus 3%, respectively. Patients needing RT2 \u2265 1 year after RT1 had superior survival compared with earlier RT2 (0.81 vs. 0.42 years;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0041). Higher RT2 dose (\u226530.6 Gy) showed a non\u2010significant trend towards longer OS (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.086). In multivariable analysis, use of RT2 was the strongest independent predictor of survival (HR 0.29, 95% CI 0.20\u20130.42;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large, multi\u2010institutional international cohort, children with DMG treated with re\u2010irradiation at progression showed a survival benefit, supporting re\u2010irradiation as a key component of salvage therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70498","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T03:37:27Z","timestamp":1785382647000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Re\u2010Irradiation in Pediatric Diffuse Midline Glioma: A Multi\u2010Institutional Retrospective Study"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6547-6797","authenticated-orcid":false,"given":"Ajay Thomas","family":"Alex","sequence":"first","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Centre University Health Network  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean P.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Centre University Health Network  Toronto Canada"},{"name":"Arthur J.E. Child Comprehensive Cancer Centre  Calgary Canada"},{"name":"Department of Oncology Division of Radiation Oncology Cumming School of Medicine University of Calgary  Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Benghiat","sequence":"additional","affiliation":[{"name":"Hall\u2010Edwards Radiotherapy Research Group Queen Elizabeth Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Herbert","sequence":"additional","affiliation":[{"name":"Hall\u2010Edwards Radiotherapy Research Group Queen Elizabeth Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Adamski","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neuro\u2010Oncology Birmingham Children Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani","family":"Bailey","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neuro\u2010Oncology Birmingham Children Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Esler","sequence":"additional","affiliation":[{"name":"Nottingham City Hospital Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Brookes","sequence":"additional","affiliation":[{"name":"Nottingham City Hospital Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Bamber","sequence":"additional","affiliation":[{"name":"Nottingham City Hospital Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Koudou","sequence":"additional","affiliation":[{"name":"Nottingham City Hospital Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Waite","sequence":"additional","affiliation":[{"name":"Nottingham City Hospital Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Bennett","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Hospital for Sick Children  Toronto Canada"},{"name":"Division of Medical Oncology and Hematology Princess Margaret Cancer Centre  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirban","family":"Das","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Hospital for Sick Children  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9762-6901","authenticated-orcid":false,"given":"Derek S.","family":"Tsang","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Centre University Health Network  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-001-0074-9"},{"key":"e_1_2_10_3_1","first-page":"4869","article-title":"Decoding Diffuse Midline Gliomas: A Comprehensive Review of Pathogenesis","volume":"15","author":"Al Sharie S.","year":"2023","journal-title":"Diagnosis and Treatment Cancers"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10555-024-10208-4"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.24.00709"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30929"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.12.043"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26988"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2025.110865"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/nop\/npaa063"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju002"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70498","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1545-5017.70498","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:18:30Z","timestamp":1787757510000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1545-5017.70498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":10,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/1545-5017.70498"],"URL":"https:\/\/doi.org\/10.1002\/1545-5017.70498","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"assertion":[{"value":"2026-05-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70498"}}