Re‐Irradiation for the Progressive Pediatric Diffuse Intrinsic Pontine Glioma: A Report on 109 Children From a Single Center

ABSTRACT Background Diffuse intrinsic pontine glioma (DIPG) is a challenging pediatric tumor that frequently progresses within the first year following local radiotherapy. However, several small studies have suggested that re‐irradiation may improve quality of life and extend overall survival. Patients and Methods This retrospective study included 109 children who experienced disease progression ≥3 months after their initial radiotherapy, and subsequently received re‐irradiation at a single institution. These patients were compared with a cohort of 60 children, meeting the same criteria, who were treated before adopting the re‐irradiation policy and received only the best supportive care (BSC). Most of the re‐irradiated children (94%) received first radiation dose as hypofractionation (39 Gy/13 fractions). Results The re‐irradiation group demonstrated significantly higher overall survival (OS) rates after the first progression, with a 6‐month OS of 42% (95% CI: 34%–53%) compared to 16% (95% CI: 8.9%–32%) in the BSC group ( p < 0.001). Re‐irradiation reduced the hazard of death by more than half (HR = 0.45, p < 0.001). Clinical response ( p < 0.001) and radiological response ( p = 0.016) were significant predictors of improved survival. While the time from initial radiotherapy to progression ( p = 0.059) and higher re‐irradiation doses ( p = 0.074) were associated with improved OS, these factors did not reach statistical significance but may represent potential prognostic indicators. Conclusion Re‐irradiation improved the OS in children with progression of DIPG and alleviated their signs and symptoms.