S1017
Clinical – Paediatric tumours
ESTRO 2026
Erik Haehl 1,2 , Anna Eichinger 3 , Michael H Albert 3 , Irene Schmid 3 , Claus Belka 1,2 , Montserrat Pazos Escudero 1,2 1 Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany. 2 Bavarian Cancer Research Center (BZKF), University Hospital, LMU Munich, Munich, Germany. 3 Dr. von Hauner Childrens' Hospital, University Hospital, LMU Munich, Munich, Germany Purpose/Objective: Despite efforts to omit total-body-irradiation (TBI) in children with acute lymphoblastic leukemia (ALL), the recent FORUM trial confirmed the superiority of TBI- based conditioning for pediatric patients. Research on long-term toxicity has mainly focused on subsequent malignancies, while data on neurocognitive outcomes remain scarce. Material/Methods: We analyzed patient-reported neurologic function in pediatric ALL-patients who had received 12Gy TBI at our institution between 2000 and 2020 and who are now adults. Surviving patients were contacted in 2025 and sent the FACT-Cognition Function scale for perceived cognitive abilities, impairments, and related quality of life. Results: We identified 77 patients treated with TBI at a median age of 9 years. At the time of the analysis, 51 (66.2%) were alive. 2, 5 and 10-year OS was 75.4% and 71.0% and 66.0%, respectively. Among surviving patients, 6 were international patients who were not accessible for follow-up, and another 6 were younger than 18 years and therefore excluded. Of 40 patients contacted, 26 returned the questionnaire, resulting in a response rate of 65%. At time of the analysis, responding patients had a median age of 25 years with a median of 17 (6-22) years between TBI and analysis. Global average FACT-Cog score was 113.0 (81-132, SD 13.1) of 132 possible points. The “Perceived Cognitive Impairment “ (PCI) subscale showed a high average of 68.5 (51-80, SD 7.3) of 72 points (high values indicating less impairment) compared to a healthy literature control with an average PCI of 63.3 (SD 6.1). A literature-derived PCI cut-off for cancer-related cognitive impairment of £53 points was exceeded in 86% of our patients. Likewise, the subscales for “Perceived Cognitive Abilities”, “Impact on Quality of Life” and “Comments from others” were comparable to the reported literature control with average values of 23.2 (17-28, SD 3.3), 13.3 (1-16, SD 3.9) and 15.0 (7-16, SD 2.0), respectively. Conclusion: In our cohort of adults who had undergone hematopoietic stem cell transplantation with TBI- based conditioning for pediatric ALL, self-reported cognitive function and quality of life were comparable to those of healthy controls, suggesting no negative
long-term effect of total-body irradiation. Keywords: TBI, ALL, Cognitive function
Digital Poster Highlight 3475 Pattern of failure in Pediatric High grade Gliomas after radiotherapy Isacco Desideri 1 , Daniela Greto 1 , Luca Visani 1 , Giulio Frosini 1 , Doruntina Cela 1 , Giulia Cesari 1 , Cecilia Petruccioli 1 , Marco Tellini 2 , Iacopo Sardi 2 , Ludovico D'Incerti 3 , Lorenzo Livi 1 1 Radiation Oncology Department - Careggi Hospital, University of Florence, Florence, Italy. 2 Neuro- Oncology Unit,, Meyer Children's Hospital IRCCS, Florence, Italy. 3 Radiology Unit, Meyer Children's Hospital IRCCS, Florence, Italy Purpose/Objective: Radiotherapy (RT) is the backbone of treatment of pediatric high grade gliomas (pHGGs), typically characterized by very high rates of treatment failures. The aim of the present study was to describe the recurrence patterns (POF) after RT. Material/Methods: RT plans were rigidly co-registered with MRI imaging at relapse of an institutional series of pHGG-patients (pts) to describe the pattern of treatment failure. Local Failures(LFs) were mapped to the planning target volume (PTV) and classified as in-field (completely within the PTV), marginal (partially within the PTV), or out-of-field (completely outside the PTV). Results: 33 relapsed HGG pts, 16 females and 17 males, with a median age of 11 years (3-21), accrued from 2012 to 2022 were retrospectively evaluated. Primary sites consisted of diffuse cerebral lesions compatible with gliomatosis cerebri (GC) in 5 (13.8%), while among focal disease presenting cases, 15 were supratentorial, 2 cerebellar and 12 located in the brainstem. 24/34 (70.5%) patients received surgery after first imaging, with 1 gross total resection, 13 partial resection and 10 biopsies. Histological analysis identifed diffuse pediatric HGG H3 wild type, IDH 1/2 wild type in 1 case, diffuse hemispheric glioma, H3 G34-mutant in four cases, diffuse midline glioma, H3 K27-altered in four case, IDH1-mutant grade 3 astrocytoma in 1 case, BRAFV600E mutated anaplastic pleomorphic xantoastrocytoma in one case, while for 10 patient the diagnosis could only be HGG. All patients underwent focal tumour bed irradiation. GTV to CTV expansion consisted of an isotropic 15mm isotropic expansion accounting for anatomical barriers;PTV was obtained by adding a 3mm isotropic margin. Radiotherapy was performed with VMAT technique with daily IGRT for a mean dose of 59,4Gy (range 54-59.4). All patients also underwent concomitant and adjuvant chemotherapy
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