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Haematotoxicity of craniospinal radiochemotherapy for metastatic paediatric high-grade glioma

Aims - Paediatric high-grade gliomas (pedHGGs) have a dismal prognosis, often characterised by early and diffuse disease progression. Novel treatment approaches are urgently needed to improve outcomes. The upcoming SIOPE-HGG (High Grade Glioma)-01 trial will investigate upfront craniospinal radioche...

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Main Authors: Valentini, Chiara (Author) , Perwein, T. (Author) , Bison, B. (Author) , Gielen, G. H. (Author) , Knerlich-Lukoschus, F. (Author) , Bock, H. C. (Author) , Seidel, C. (Author) , Kortmann, R. D. (Author) , Sturm, D. (Author) , Benesch, M. (Author) , Nussbaumer, G. (Author) , Krischer, J. M. (Author) , von Bueren, A. O. (Author) , Eyrich, M. (Author) , Friker, L. L. (Author) , Hoffmann, M. (Author) , Gkika, E. (Author) , Wittig-Sauerwein, A. (Author) , Hörner-Rieber, J. (Author) , Schwarz, R. (Author) , Jablonska, K. (Author) , Hoffmann, W. (Author) , Vordermark, D. (Author) , Rieken, S. (Author) , Höng, L. (Author) , Rödel, C. (Author) , Timmermann, B. (Author) , Fennell, J. T. (Author) , Claviez, A. (Author) , Karremann, Michael (Author) , Kramm, C. M. (Author) , Krause, M. (Author)
Format: Article (Journal)
Language:English
Published: December 2025
In: Clinical oncology
Year: 2025, Volume: 48, Pages: 1-8
ISSN:1433-2981
DOI:10.1016/j.clon.2025.103956
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.clon.2025.103956
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0936655525002110
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Author Notes:C. Valentini, T. Perwein, B. Bison, G.H. Gielen, F. Knerlich-Lukoschus, H.C. Bock, C. Seidel, R.D. Kortmann, D. Sturm, M. Benesch, G. Nussbaumer, J.M. Krischer, A.O. von Bueren, M. Eyrich, L.L. Friker, M. Hoffmann, E. Gkika, A. Wittig-Sauerwein, J. Hörner-Rieber, R. Schwarz, K. Jablonska, W. Hoffmann, D. Vordermark, S. Rieken, L. Höng, C. Rödel, B. Timmermann, J.T. Fennell, A. Claviez, M. Karremann, C.M. Kramm, M. Krause
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Summary:Aims - Paediatric high-grade gliomas (pedHGGs) have a dismal prognosis, often characterised by early and diffuse disease progression. Novel treatment approaches are urgently needed to improve outcomes. The upcoming SIOPE-HGG (High Grade Glioma)-01 trial will investigate upfront craniospinal radiochemotherapy (CSI-RCT) for newly diagnosed, nonmetastatic diffuse midline glioma/diffuse intrinsic pontine glioma (DMG/DIPG). As CSI-RCT is frequently avoided due to concerns over haematotoxicity, real-world feasibility data are critically needed. - Materials and methods - We retrospectively assessed haematological toxicity in 19 patients (aged 3-21 years) with metastatic pedHGG treated with CSI-RCT within the hirn tumor glioblastoma trial (HIT-HGG) and hospital in trial-glioblastoma (HIT-GBM) trial programmes (2002-2024). All patients received craniospinal irradiation (median dose: 35.2 Gy) using photon- or proton-based techniques, with concurrent chemotherapy: temozolomide (TMZ; n = 14) or PEI (cisplatin, etoposide, ifosfamide; n = 5). Haematological toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. - Results - Grade 3 to 4 haematotoxicity was observed in 7 of 19 patients (36.8%). Chemotherapy was discontinued in two cases—one due to TMZ-induced aplastic anaemia (TIAA) and another due to thrombocytopaenia. The remaining patients tolerated full-dose CSI-RCT with manageable side effects, and no unplanned radiotherapy interruptions occurred. The haematotoxicity rate was comparable to or lower than previous reports, indicating that CSI-RCT is feasible with appropriate monitoring and management. - Conclusion - This is the largest cohort to date assessing haematological toxicity of upfront CSI-RCT in metastatic pedHGG. Despite notable haematotoxicity, treatment was largely feasible and well-tolerated. These findings support the integration of CSI-RCT into future clinical trials for newly diagnosed DMG/DIPG and provide a foundation for the upcoming SIOPE HGG-01 trial. Proton therapy may further reduce toxicity and warrants prospective evaluation.
Item Description:Gesehen am 20.01.2026
Physical Description:Online Resource
ISSN:1433-2981
DOI:10.1016/j.clon.2025.103956

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