{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:12:41Z","timestamp":1787314361849,"version":"build-2736575974"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this study is to investigate the spectrum of neurological triad improvement in patients with diffuse intrinsic pontine glioma (DIPG) treated by re-irradiation (re-RT) at first progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We carried out a re-analysis of the SIOP-E retrospective DIPG cohort by investigating the clinical benefits after re-RT with a focus on the neurological triad (cranial nerve deficits, ataxia, and long tract signs). Patients were categorized as \u201cresponding\u201d or \u201cnon-responding\u201d to re-RT. To assess the interdependence between patients\u2019 characteristics and clinical benefits, we used a chi-square or Fisher\u2019s exact test. Survival according to clinical response to re-RT was calculated by the Kaplan\u2013Meier method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      As earlier reported, 77% (\n                      <jats:italic>n<\/jats:italic>\n                      = 24\/31) of patients had any clinical benefit after re-RT. Among 25\/31 well-documented patients, 44% (\n                      <jats:italic>n<\/jats:italic>\n                      = 11\/25) had improvement in cranial nerve palsies, 40% (\n                      <jats:italic>n<\/jats:italic>\n                      = 10\/25) had improvement in long-tract signs, and 44% (11\/25) had improvement in cerebellar signs. Clinical benefits were observed in at least 1, 2, or 3 out of 3 symptoms of the DIPG triad, in 64%, 40%, and 24%, respectively. Patients irradiated with a dose \u226520 Gy versus &amp;lt;20 Gy may improve slightly better with regard to ataxia (67% versus 23%;\n                      <jats:italic>p<\/jats:italic>\n                      -value = 0.028). The survival from the start of re-RT to death was not different between responding and non-responding DIPG patients (\n                      <jats:italic>p<\/jats:italic>\n                      -value = 0.871).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A median re-irradiation dose of 20 Gy provides a neurological benefit in two-thirds of patients with an improvement of at least one symptom of the triad. DIPG patients receiving \u226520 Gy appear to improve slightly better with regard to ataxia; however, we need more data to determine whether dose escalation up to 30 Gy provides additional benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2022.926196","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T17:45:32Z","timestamp":1655919932000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Neurological Symptom Improvement After Re-Irradiation in Patients With Diffuse Intrinsic Pontine Glioma: A Retrospective Analysis of the SIOP-E-HGG\/DIPG Project"],"prefix":"10.3389","volume":"12","author":[{"given":"Lara","family":"Chavaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert O.","family":"Janssens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Bolle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Mandeville","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Ramos-Albiac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Van Beek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Benghiat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Hoeben","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Morales La Madrid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Seidel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf-Dieter","family":"Kortmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Hargrave","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Gandola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Pecori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dannis G.","family":"van Vuurden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Biassoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura","family":"Massimino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof M.","family":"Kramm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre O.","family":"von Bueren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.593192","article-title":"Canadian Pediatric Neuro-Oncology Standards of Practice","volume":"10","author":"Bennett","year":"2020","journal-title":"Front Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s11060-020-03415-w","article-title":"Radiation Dose Response of Neurologic Symptoms During Conformal Radiotherapy for Diffuse Intrinsic Pontine Glioma","volume":"147","author":"Tinkle","year":"2020","journal-title":"J Neurooncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2015.00237","article-title":"DIPG in Children - What Can We Learn From the Past","volume":"5","author":"Vanan","year":"2015","journal-title":"Front Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2012.00205","article-title":"Diffuse Intrinsic Pontine Glioma: Poised for Progress","volume":"2","author":"Warren","year":"2012","journal-title":"Front Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.04.006","article-title":"Hypofractionation vs Conventional Radiation Therapy for Newly Diagnosed Diffuse Intrinsic Pontine Glioma: A Matched-Cohort Analysis","volume":"85","author":"Janssens","year":"2013","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.04.6599","article-title":"Advances Toward an Understanding of Brainstem Gliomas","volume":"24","author":"Donaldson","year":"2006","journal-title":"J Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.ejca.2016.12.007","article-title":"Survival Benefit for Patients With Diffuse Intrinsic Pontine Glioma (DIPG) Undergoing Re-Irradiation at First Progression: A Matched-Cohort Analysis on Behalf of the SIOP-E-HGG\/DIPG Working Group","volume":"73","author":"Janssens","year":"2017","journal-title":"Eur J Cancer Oxf Engl 1990"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0b013e318201a2b7","article-title":"Palliative Reirradiation for Progressive Diffuse Intrinsic Pontine Glioma","volume":"35","author":"Fontanilla","year":"2012","journal-title":"Am J Clin Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-014-1428-z","article-title":"Results of Nimotuzumab and Vinorelbine, Radiation and Re-Irradiation for Diffuse Pontine Glioma in Childhood","volume":"118","author":"Massimino","year":"2014","journal-title":"J Neurooncol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.prro.2016.11.005","article-title":"Radiation and Subsequent Reirradiation Outcomes in the Treatment of Diffuse Intrinsic Pontine Glioma and a Systematic Review of the Reirradiation Literature","volume":"7","author":"Freese","year":"2017","journal-title":"Pract Radiat Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nox107","article-title":"Contemporary Survival Endpoints: An International Diffuse Intrinsic Pontine Glioma Registry Study","volume":"19","author":"Cooney","year":"2017","journal-title":"Neuro-Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26988","article-title":"Reirradiation in Patients With Diffuse Intrinsic Pontine Gliomas: The Canadian Experience","volume":"65","author":"Lassaletta","year":"2018","journal-title":"Pediatr Blood Cancer"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-018-2991-5","article-title":"Reirradiation and PD-1 Inhibition With Nivolumab for the Treatment of Recurrent Diffuse Intrinsic Pontine Glioma: A Single-Institution Experience","volume":"140","author":"Kline","year":"2018","journal-title":"J Neurooncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.12.043","article-title":"A Phase 1\/2 Trial of Reirradiation for Diffuse Intrinsic Pontine Glioma","volume":"104","author":"Amsbaugh","year":"2019","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-019-04118-y","article-title":"Reirradiation for Diffuse Intrinsic Pontine Glioma: A Systematic Review and Meta-Analysis","volume":"35","author":"Lu","year":"2019","journal-title":"Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/mds.22681","article-title":"Development of a Brief Ataxia Rating Scale (BARS) Based on a Modified Form of the ICARS","volume":"24","author":"Schmahmann","year":"2009","journal-title":"Mov Disord Off J Mov Disord Soc"},{"key":"B17","unstructured":"HRQL and Symptom Assessment for Patients With DIPG or Recurrent and Re-Irradiated Brain Tumours and Their Caregivers"}],"updated-by":[{"DOI":"10.3389\/fonc.2023.1182994","type":"erratum","label":"Erratum","source":"publisher","updated":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000}}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.926196\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T10:21:21Z","timestamp":1680085281000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.926196\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,22]]},"references-count":17,"alternative-id":["10.3389\/fonc.2022.926196"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.926196","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,22]]},"article-number":"926196"}}