Early Radiotherapy Preserves Vision in Certain Children With Glioma

According to the results of a longitudinal cohort study published in Cancer, early radiation therapy may maintain visual acuity in certain children with sporadic optic pathway / hypothalamic glioma.

The cohort included 38 children diagnosed with sporadic optic pathway / hypothalamic glioma from 2000 to 2018 at Texas Children’s Cancer Center in Houston, Texas.

Children were grouped based on whether they received early radiation therapy, which was defined as first-line treatment or first-salvage therapy, and their visual acuity was assessed at baseline and at least every 12 weeks during treatment.

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Blindness-free survival (BFS) was the primary endpoint, and blindness was defined as 0.8 LogMAR (logarithm of the minimum resolution angle) or worse, which is the default threshold used by most states to determine legal blindness.

The median follow-up was 8.5 years (range 2-17 years) and in the cohort, sporadic optic pathway / hypothalamic glioma was established at a median age of 3 years (interquartile range [IQR], <1-6 years).

A total of 27 children (71%) were assigned to the chemotherapy group, for which chemotherapy was the first treatment and radiotherapy as late burst therapy was allowed. This group started chemotherapy at a median age of 3.5 years (range, <1-11 years).

The early radiotherapy group included 11 children (29%), who were mostly older. These children were diagnosed at a median age of 6 years (range 2-16 years) and received radiotherapy for an average of 2.5 years after diagnosis (IQR, 0.3-9.5 years).

Children who received early radiotherapy had a blindness-free survival (BFS) of 100% at 5 and 8 years, while children who did not have BFS of 81% at 5 years and 60% at 8 years (P = 0.017). ). All children were alive at the last follow-up.

In addition, BFS did not differ by age (children less than 5 years of age versus children 5 years of age or older; P = 0.67) and was not significantly different between patients in the chemotherapy group who received late salvage radiation compared to those who did not. did (P = .93).

The study authors concluded that their findings suggest that early radiotherapy preserves functional vision in the “appropriately selected elderly patient” and should be considered after a “significant” decrease in visual acuity.

Reference

Hanania AN, Paulino AC, Ludmir EB, et al. Early radiotherapy preserves vision in sporadic glioma of the optic pathway. Cancer. Published online March 19, 2021.doi: 10.1002 / cncr.33497

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