SynthesisAsian Pacific journal of cancer prevention : APJCP2025
Evaluating the Role of Re-Irradiation in the Management of DIPG: A Systematic Review and Meta-Analysis of Current Evidence.
Synthesis in Asian Pacific journal of cancer prevention : APJCP, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
objectiveOverall survival (OS) of patients with diffuse intrinsic pontine glioma (DIPG) is poor. Re-irradiation (re-RT) represents an emerging strategy aimed at improving outcomes for patients who experience recurrence or progression after initial radiation therapy (RT). While re-RT is increasingly used at progression, its survival benefit lacks robust quantification. This systematic review and meta-analysis aims to evaluate the impact of re-RT timing on OS and toxicity in pediatric DIPG.
methodsThis review was conducted in the PubMed/MEDLINE, Europe PMC, and Scopus (2014-2024), following PRISMA guidelines. Meta-analysis used random-effects models to pool OS after re-RT (primary outcome). Heterogeneity was quantified via I2 statistics. Secondary outcomes included symptom improvement and grade ≥3 toxicity.
resultFourteen studies (n=357) were included. The pooled median OS after re-RT was 9.5 months (95%CI: 5.34-13.71), though substantial heterogeneity existed (I2=98.9%, p <0.001). Patients receiving re-RT had longer median OS from diagnosis than non-re-RT counterparts (20.8 vs. 8.3 months). Neurological symptom improvement occurred in 64-100% of patients, with triad symptoms (ataxia, cranial neuropathy, long-tract signs) showing greatest responsiveness. Only 1.4% (5/357 patients) experienced grade ≥3 complications (dysphagia, pontine necrosis, hemorrhage). The pooled hazard ratio (HR) or re-RT versus non-re-RT groups was 0.43 (95%CI: 0.28-0.67), indicating a 57% reduction in mortality risk.
conclusionThis meta-analysis establishes that re-RT confers a statistically significant and clinically meaningful survival extension (median 9.5 months post re-RT), with low severe toxicity risk. While high heterogeneity reflects protocol variations (e.g., longer OS with >30 Gy regimens), re-RT consistently outperforms non-re-RT approaches. Re-RT also significantly reduces mortality risk (HR=0.43). We recommend standardized regimens using 1.8-2.0 Gy per fraction (≤24 Gy total) to optimize survival while minimizing toxicity. Future trials should prioritize dose optimization and patient stratification.
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