S1007
Clinical – Paediatric tumours
ESTRO 2026
Digital Poster Highlight 1885 Survival and Hematotoxicity of upfront craniospinal versus focal Radio-chemotherapy in metastatic pediatric High-Grade Gliomas. Chiara Valentini 1 , Thomas Perwein 2 , Brigitte Bison 3 , Gerrit H Gielen 4 , Lea L Friker 4 , Clemens Seidel 5 , Rolf Dieter Kortmann 5 , Martin Benesch 2 , Gunter Nussbaumer 2 , Jeanne-Marie Krischer 6 , Marion Hoffmann 6 , Michael Karremann 7 , Christoph Maria Kramm 6 , Mechthild Krause 1,8 1 Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus at TUD, Dresden, Germany. 2 Division of Pediatric Hemato-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria. 3 Diagnostik and Interventional Neuroradiology, Faculty of Medicine, University Augsburg, Augsburg, Germany. 4 Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany. 5 Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany. 6 Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany. 7 Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Mannheim, Germany. 8 OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum, Dresden, Germany Purpose/Objective: Pediatric high-grade gliomas (pedHGG) account for 10–20% of pediatric CNS tumors and are associated with a dismal prognosis, with a median survival below one year. Although radiotherapy can modestly extend survival, leptomeningeal dissemination and metastatic progression remain major challenges. This study compares hematotoxicity and overall survival in patients with metastatic pedHGG at diagnosis, treated within the HIT-HGG/GBM studies, who received either focal radiochemotherapy or craniospinal radiochemotherapy with a boost to the primary tumor site as primary treatment. Material/Methods: The cohort included 38 patients (aged 3–21 years) with newly diagnosed metastatic pedHGG (including DIPG/DMG) who received either focal radiotherapy or CSI with a boost on primary tumor alongside chemotherapy according to the HIT-HGG/GBM studies. Hematotoxicity was assessed per CTCAE v4.0, and treatment interruptions were recorded. Overall survival was analyzed using Kaplan–Meier estimates, and statistical analyses were conducted with SPSS (IBM, Version 30.0.0, 2024). Results:
CSI and higher mean dose to the whole brain, left hippocampus, brainstem, cerebellum and cerebrum were significantly associated with PS impairment (Table 1). Predicted probabilities of PS impairment derived from the univariate analysis for the whole brain and left hippocampus are presented in Figure 1. Table1 Results from univariate logistic regression
Figure1 Predicted probabilities (95% CI) of cognitive PS impairment from univariate analysis. Each point denotes one of five dose-stratified groups, with the observed proportion of PS impairment (95% CI) plotted against the mean dose for that group. Conclusion: Dose-response models suggested a potential association of dose to brain substructures and cognitive PS. However, a mixed population of focal and CSI treatment and strong intercorrelations among dose metrics limited the ability to identify the most relevant dose parameters. The contribution of radiation dose to the risk of PS impairment cannot be clearly separated from potential effects of the primary diagnosis and associated treatments, including surgery and chemotherapy. Studies with larger patient cohorts and a wider range of cognitive measures are warranted to clarify these relationships. Keywords: Neurocognition, dose-response model, brain tumor
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