เนื้องอกสมองชนิด Diffuse Brain stem glioma (DIPG) ในผู้ป่วยเด็ก
Abstract
เนื้องอกบริเวณก้านสมองเป็นคำรวมของกลุ่มเนื้องอกหลายๆชนิดที่มีตำแหน่งเกิดบริเวณก้านสมอง ซึ่งส่วนมากเป็น เนื้องอกชนิดไกลโอมา (glioma) โดยสามารถแบ่งได้เป็นสองกลุ่ม คือกลุ่มเนื้องอกก้านสมองเฉพาะจุด (focal tumors) และ เนื้องอกก้านสมองชนิดแทรกซึมโดยทั่ว (diffuse infiltrating tumors) ซึ่งในแบบหลังมักพบบริเวณก้านสมองส่วนพอน (Pons) จึงมักเรียกว่า Diffuse Intrinsic Pontine Glioma (DIPG) โดย DIPG เป็นเนื้องอกที่มีการพยากรณ์โรคไม่ดี ไม่สามารถผ่าตัด เอาก้อนออกทั้งหมดได้ ดังนั้นการฉายรังสีจึงเป็นการรักษาหลักที่มีบทบาทสำคัญ เพื่อบรรเทาอาการจากโรค และเพิ่มมัธยฐาน ระยะเวลาการรอดชีวิต (median survival) อย่างไรก็ตาม ค่ามัธยฐานระยะเวลาการรอดชีวิตของเนื้องอก DIPG นั้นอยู่ที่เพียง ประมาณหนึ่งปี ปัจจุบันจึงมีการศึกษาทางชีววิทยาโมเลกุลและพยาธิวิทยาของเนื้องอกชนิดนี้มากขึ้น เพื่อพัฒนาการรักษาที่มี ประสิทธิภาพมากขึ้นในอนาคต
References
Donaldson SS, Laningham F, Fisher PG. Advances toward an understanding of brainstem gliomas. J Clin Oncol 2006;24:1266-72.
Fisher PG, Breiter SN, Carson BS, Wharam MD, Williams JA, Weingart JD, et al. A clinicopathologic reappraisal of brain stem tumor classification. Identification of pilocystic astrocytoma and fibrillary astrocytoma as distinct entities. Cancer 2000;89:1569-76.
Warren KE. Diffuse intrinsic pontine glioma: poised for progress. Front Oncol 2012;2:205.
Vanan MI, Eisenstat DD. DIPG in Children - What Can We Learn from the Past? Front Oncol 2015;5:237.
Perez C, Brady L, Halperin E, Wazer D. Perez and Brady's principles and practice of radiation oncology. 6th ed. Philadelphia, Pa: Wolters Kluwer; 2013.
Johung TB, Monje M. Diffuse Intrinsic Pontine Glioma: New Pathophysiological Insights and Emerging Therapeutic Targets. Curr Neuropharmacol 2017;15:88-97.
Barkovich AJ, Krischer J, Kun LE, Packer R, Zimmerman RA, Freeman CR, et al. Brain stem gliomas: a classification system based on magnetic resonance imaging. Pediatr Neurosurg 1990;16:73-83.
Poussaint TY, Kocak M, Vajapeyam S, Packer RI, Robertson RL, Geyer R, et al. MRI as a central component of clinical trials analysis in brainstem glioma: a report from the Pediatric Brain Tumor Consortium (PBTC). Neuro Oncol 2011;13:417-27.
Jansen MH, Veldhuijzen van Zanten SE, Sanchez Aliaga E, Heymans MW, Warmuth-Metz M, Hargrave D, et al. Survival prediction model of children with diffuse intrinsic pontine glioma based on clinical and radiological criteria. Neuro Oncol 2015;17:160-6.
Albright AL, Packer RJ, Zimmerman R, Rorke LB, Boyett J, Hammond GD. Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the Children's Cancer Group. Neurosurgery 1993;33:1026-9; discussion 9-30.
Haas-Kogan DA, Banerjee A, Poussaint TY, Kocak M, Prados MD, Geyer JR, et al. Phase II trial of tipifarnib and radiation in children with newly diagnosed diffuse intrinsic pontine gliomas. Neuro Oncol 2011;13:298-306.
Janssens GO, Gandola L, Bolle S, Mandeville H, Ramos-Albiac M, van Beek K, et al. Survival benefit for patients with diffuse intrinsic pontine glioma (DIPG) undergoing re-irradiation at first progression: A matched-cohort analysis on behalf of the SIOP-E-HGG/DIPG working group. European Journal of Cancer 2017;73:38-47.
Kieran MW. Time to rethink the unthinkable: upfront biopsy of children with newly diagnosed diffuse intrinsic pontine glioma (DIPG). Pediatr Blood Cancer 2015;62:3-4.
Roujeau T, Machado G, Garnett MR, Miquel C, Puget S, Geoerger B, et al. Stereotactic biopsy of diffuse pontine lesions in children. J Neurosurg 2007;107:1-4.
Schumacher M, Schulte-Monting J, Stoeter P, Warmuth-Metz M, Solymosi L. Magnetic resonance imaging compared with biopsy in the diagnosis of brainstem diseases of childhood: a multicenter review. J Neurosurg 2007;106:111-9.
Grigsby PW, Garcia DM, Ghiselli R. Analysis of autopsy findings in patients treated with irradiation for thalamic and brain stem tumors. Am J Clin Oncol 1989;12:255-8.
Yoshimura J, Onda K, Tanaka R, Takahashi H. Clinicopathological study of diffuse type brainstem gliomas: analysis of 40 autopsy cases. Neurol Med Chir (Tokyo) 2003;43:375-82; discussion 82.
Warren KE, Killian K, Suuriniemi M, Wang Y, Quezado M, Meltzer PS. Genomic aberrations in pediatric diffuse intrinsic pontine gliomas. Neuro Oncol 2012;14:326-32.
Laigle-Donadey F, Doz F, Delattre JY. Brainstem gliomas in children and adults. Curr Opin Oncol 2008;20:662-7.
Hargrave D, Bartels U, Bouffet E. Diffuse brainstem glioma in children: critical review of clinical trials. Lancet Oncol 2006;7:241-8.
Edwards MS, Wara WM, Urtasun RC, Prados M, Levin VA, Fulton D, et al. Hyperfractionated radiation therapy for brain-stem glioma: a phase I-II trial. J Neurosurg 1989;70:691-700.
Buczkowicz P, Bartels U, Bouffet E, Becher O, Hawkins C. Histopathological spectrum of paediatric diffuse intrinsic pontine glioma: diagnostic and therapeutic implications. Acta Neuropathol 2014;128:573-81.
Caretti V, Bugiani M, Freret M, Schellen P, Jansen M, van Vuurden D, et al. Subventricular spread of diffuse intrinsic pontine glioma. Acta Neuropathol 2014;128:605-7.
Mahajan A, Paulino A. Radiation Oncology for Pediatric CNS Tumors. Cham: Springer Nature; 2018.
Gunderson L, Tepper J, Bogart J. Clinical radiation oncology. 4th ed. Philadelphia, PA: Elsevier; 2016.
Freeman CR. Hyperfractionated radiotherapy for diffuse intrinsic brain stem tumors in children. Pediatr Neurosurg 1996;24:103-10.
Mandell LR, Kadota R, Freeman C, Douglass EC, Fontanesi J, Cohen ME, et al. There is no role for hyperfractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brainstem tumors: results of a Pediatric Oncology Group phase III trial comparing conventional vs. hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys 1999;43:959-64.
Lewis J, Lucraft H, Gholkar A. UKCCSG study of accelerated radiotherapy for pediatric brain stem gliomas. United Kingdom Childhood Cancer Study Group. Int J Radiat Oncol Biol Phys 1997;38:925-9.
Janssens GO, Jansen MH, Lauwers SJ, Nowak PJ, Oldenburger FR, Bouffet E, et al. Hypofractionation vs conventional radiation therapy for newly diagnosed diffuse intrinsic pontine glioma: a matched-cohort analysis. Int J Radiat Oncol Biol Phys 2013;85:315-20.
Negretti L, Bouchireb K, Levy-Piedbois C, Habrand JL, Dhermain F, Kalifa C, et al. Hypofractionated radiotherapy in the treatment of diffuse intrinsic pontine glioma in children: a single institution's experience. J Neurooncol 2011;104:773-7.
Zaghloul MS, Eldebawy E, Ahmed S, Mousa AG, Amin A, Refaat A, et al. Hypofractionated conformal radiotherapy for pediatric diffuse intrinsic pontine glioma (DIPG): a randomized controlled trial. Radiother Oncol 2014;111:35-40.
Sison J, Tran H, Margol A, Tiwari N, Garcia KM, Cotter J, et al. Palliative Care Options for a Young Adult Patient with a Diffuse Intrinsic Pontine Glioma. Cureus 2017;9:e1580.
Jenkin RD, Boesel C, Ertel I, Evans A, Hittle R, Ortega J, et al. Brain-stem tumors in childhood: a prospective randomized trial of irradiation with and without adjuvant CCNU, VCR, and prednisone. A report of the Childrens Cancer Study Group. J Neurosurg 1987;66:227-33.
Freeman CR, Kepner J, Kun LE, Sanford RA, Kadota R, Mandell L, et al. A detrimental effect of a combined chemotherapy-radiotherapy approach in children with diffuse intrinsic brain stem gliomas? Int J Radiat Oncol Biol Phys 2000;47:561-4.
Kretschmar CS, Tarbell NJ, Barnes PD, Krischer JP, Burger PC, Kun L. Pre-irradiation chemotherapy and hyperfractionated radiation therapy 66 Gy for children with brain stem tumors. A phase II study of the Pediatric Oncology Group, Protocol 8833. Cancer 1993;72:1404-13.
Dunkel IJ, Garvin JH, Jr., Goldman S, Ettinger LJ, Kaplan AM, Cairo M, et al. High dose chemotherapy with autologous bone marrow rescue for children with diffuse pontine brain stem tumors. Children's Cancer Group. J Neurooncol 1998;37:67-73.
Bailey S, Howman A, Wheatley K, Wherton D, Boota N, Pizer B, et al. Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy – Results of a United Kingdom phase II trial (CNS 2007 04). European Journal of Cancer 2013;49:3856-62.
Bernier-Chastagner V, Grill J, Doz F, Bracard S, Gentet JC, Marie-Cardine A, et al. Topotecan as a radiosensitizer in the treatment of children with malignant diffuse brainstem gliomas: results of a French Society of Paediatric Oncology Phase II Study. Cancer 2005;104:2792-7.
Turner CD, Chi S, Marcus KJ, MacDonald T, Packer RJ, Poussaint TY, et al. Phase II study of thalidomide and radiation in children with newly diagnosed brain stem gliomas and glioblastoma multiforme. J Neurooncol 2007;82:95-101.
Doz F, Neuenschwander S, Bouffet E, Gentet JC, Schneider P, Kalifa C, et al. Carboplatin before and during radiation therapy for the treatment of malignant brain stem tumours: a study by the Societe Francaise d'Oncologie Pediatrique. Eur J Cancer 2002;38:815-9.
Frappaz D, Schell M, Thiesse P, Marec-Berard P, Mottolese C, Perol D, et al. Preradiation chemotherapy may improve survival in pediatric diffuse intrinsic brainstem gliomas: final results of BSG 98 prospective trial. Neuro Oncol 2008;10:599-607.
Massimino M, Biassoni V, Miceli R, Schiavello E, Warmuth-Metz M, Modena P, et al. Results of nimotuzumab and vinorelbine, radiation and re-irradiation for diffuse pontine glioma in childhood. J Neurooncol 2014;118:305-12.
Pollack IF, Jakacki RI, Butterfield LH, Hamilton RL, Panigrahy A, Potter DM, et al. Antigen-specific immune responses and clinical outcome after vaccination with glioma-associated antigen peptides and polyinosinic-polycytidylic acid stabilized by lysine and carboxymethylcellulose in children with newly diagnosed malignant brainstem and nonbrainstem gliomas. J Clin Oncol 2014;32:2050-8.
Grill J, Bhangoo R. Recent development in chemotherapy of paediatric brain tumours. Curr Opin Oncol 2007;19:612-5.
Jansen MH, van Vuurden DG, Vandertop WP, Kaspers GJ. Diffuse intrinsic pontine gliomas: a systematic update on clinical trials and biology. Cancer Treat Rev 2012;38:27-35.
Johnson KJ, Cullen J, Barnholtz-Sloan JS, Ostrom QT, Langer CE, Turner MC, et al. Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review. Cancer Epidemiol Biomarkers Prev 2014;23:2716-36.
Wolff JE, Rytting ME, Vats TS, Zage PE, Ater JL, Woo S, et al. Treatment of recurrent diffuse intrinsic pontine glioma: the MD Anderson Cancer Center experience. J Neurooncol 2012;106:391-7.
Broniscer A, Laningham FH, Sanders RP, Kun LE, Ellison DW, Gajjar A. Young age may predict a better outcome for children with diffuse pontine glioma. Cancer 2008;113:566-72.
Fontanilla HP, Pinnix CC, Ketonen LM, Woo SY, Vats TS, Rytting ME, et al. Palliative reirradiation for progressive diffuse intrinsic pontine glioma. Am J Clin Oncol 2012;35:51-7.
Fisher PG, Breiter SN, Carson BS, Wharam MD, Williams JA, Weingart JD, et al. A clinicopathologic reappraisal of brain stem tumor classification. Identification of pilocystic astrocytoma and fibrillary astrocytoma as distinct entities. Cancer 2000;89:1569-76.
Warren KE. Diffuse intrinsic pontine glioma: poised for progress. Front Oncol 2012;2:205.
Vanan MI, Eisenstat DD. DIPG in Children - What Can We Learn from the Past? Front Oncol 2015;5:237.
Perez C, Brady L, Halperin E, Wazer D. Perez and Brady's principles and practice of radiation oncology. 6th ed. Philadelphia, Pa: Wolters Kluwer; 2013.
Johung TB, Monje M. Diffuse Intrinsic Pontine Glioma: New Pathophysiological Insights and Emerging Therapeutic Targets. Curr Neuropharmacol 2017;15:88-97.
Barkovich AJ, Krischer J, Kun LE, Packer R, Zimmerman RA, Freeman CR, et al. Brain stem gliomas: a classification system based on magnetic resonance imaging. Pediatr Neurosurg 1990;16:73-83.
Poussaint TY, Kocak M, Vajapeyam S, Packer RI, Robertson RL, Geyer R, et al. MRI as a central component of clinical trials analysis in brainstem glioma: a report from the Pediatric Brain Tumor Consortium (PBTC). Neuro Oncol 2011;13:417-27.
Jansen MH, Veldhuijzen van Zanten SE, Sanchez Aliaga E, Heymans MW, Warmuth-Metz M, Hargrave D, et al. Survival prediction model of children with diffuse intrinsic pontine glioma based on clinical and radiological criteria. Neuro Oncol 2015;17:160-6.
Albright AL, Packer RJ, Zimmerman R, Rorke LB, Boyett J, Hammond GD. Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the Children's Cancer Group. Neurosurgery 1993;33:1026-9; discussion 9-30.
Haas-Kogan DA, Banerjee A, Poussaint TY, Kocak M, Prados MD, Geyer JR, et al. Phase II trial of tipifarnib and radiation in children with newly diagnosed diffuse intrinsic pontine gliomas. Neuro Oncol 2011;13:298-306.
Janssens GO, Gandola L, Bolle S, Mandeville H, Ramos-Albiac M, van Beek K, et al. Survival benefit for patients with diffuse intrinsic pontine glioma (DIPG) undergoing re-irradiation at first progression: A matched-cohort analysis on behalf of the SIOP-E-HGG/DIPG working group. European Journal of Cancer 2017;73:38-47.
Kieran MW. Time to rethink the unthinkable: upfront biopsy of children with newly diagnosed diffuse intrinsic pontine glioma (DIPG). Pediatr Blood Cancer 2015;62:3-4.
Roujeau T, Machado G, Garnett MR, Miquel C, Puget S, Geoerger B, et al. Stereotactic biopsy of diffuse pontine lesions in children. J Neurosurg 2007;107:1-4.
Schumacher M, Schulte-Monting J, Stoeter P, Warmuth-Metz M, Solymosi L. Magnetic resonance imaging compared with biopsy in the diagnosis of brainstem diseases of childhood: a multicenter review. J Neurosurg 2007;106:111-9.
Grigsby PW, Garcia DM, Ghiselli R. Analysis of autopsy findings in patients treated with irradiation for thalamic and brain stem tumors. Am J Clin Oncol 1989;12:255-8.
Yoshimura J, Onda K, Tanaka R, Takahashi H. Clinicopathological study of diffuse type brainstem gliomas: analysis of 40 autopsy cases. Neurol Med Chir (Tokyo) 2003;43:375-82; discussion 82.
Warren KE, Killian K, Suuriniemi M, Wang Y, Quezado M, Meltzer PS. Genomic aberrations in pediatric diffuse intrinsic pontine gliomas. Neuro Oncol 2012;14:326-32.
Laigle-Donadey F, Doz F, Delattre JY. Brainstem gliomas in children and adults. Curr Opin Oncol 2008;20:662-7.
Hargrave D, Bartels U, Bouffet E. Diffuse brainstem glioma in children: critical review of clinical trials. Lancet Oncol 2006;7:241-8.
Edwards MS, Wara WM, Urtasun RC, Prados M, Levin VA, Fulton D, et al. Hyperfractionated radiation therapy for brain-stem glioma: a phase I-II trial. J Neurosurg 1989;70:691-700.
Buczkowicz P, Bartels U, Bouffet E, Becher O, Hawkins C. Histopathological spectrum of paediatric diffuse intrinsic pontine glioma: diagnostic and therapeutic implications. Acta Neuropathol 2014;128:573-81.
Caretti V, Bugiani M, Freret M, Schellen P, Jansen M, van Vuurden D, et al. Subventricular spread of diffuse intrinsic pontine glioma. Acta Neuropathol 2014;128:605-7.
Mahajan A, Paulino A. Radiation Oncology for Pediatric CNS Tumors. Cham: Springer Nature; 2018.
Gunderson L, Tepper J, Bogart J. Clinical radiation oncology. 4th ed. Philadelphia, PA: Elsevier; 2016.
Freeman CR. Hyperfractionated radiotherapy for diffuse intrinsic brain stem tumors in children. Pediatr Neurosurg 1996;24:103-10.
Mandell LR, Kadota R, Freeman C, Douglass EC, Fontanesi J, Cohen ME, et al. There is no role for hyperfractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brainstem tumors: results of a Pediatric Oncology Group phase III trial comparing conventional vs. hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys 1999;43:959-64.
Lewis J, Lucraft H, Gholkar A. UKCCSG study of accelerated radiotherapy for pediatric brain stem gliomas. United Kingdom Childhood Cancer Study Group. Int J Radiat Oncol Biol Phys 1997;38:925-9.
Janssens GO, Jansen MH, Lauwers SJ, Nowak PJ, Oldenburger FR, Bouffet E, et al. Hypofractionation vs conventional radiation therapy for newly diagnosed diffuse intrinsic pontine glioma: a matched-cohort analysis. Int J Radiat Oncol Biol Phys 2013;85:315-20.
Negretti L, Bouchireb K, Levy-Piedbois C, Habrand JL, Dhermain F, Kalifa C, et al. Hypofractionated radiotherapy in the treatment of diffuse intrinsic pontine glioma in children: a single institution's experience. J Neurooncol 2011;104:773-7.
Zaghloul MS, Eldebawy E, Ahmed S, Mousa AG, Amin A, Refaat A, et al. Hypofractionated conformal radiotherapy for pediatric diffuse intrinsic pontine glioma (DIPG): a randomized controlled trial. Radiother Oncol 2014;111:35-40.
Sison J, Tran H, Margol A, Tiwari N, Garcia KM, Cotter J, et al. Palliative Care Options for a Young Adult Patient with a Diffuse Intrinsic Pontine Glioma. Cureus 2017;9:e1580.
Jenkin RD, Boesel C, Ertel I, Evans A, Hittle R, Ortega J, et al. Brain-stem tumors in childhood: a prospective randomized trial of irradiation with and without adjuvant CCNU, VCR, and prednisone. A report of the Childrens Cancer Study Group. J Neurosurg 1987;66:227-33.
Freeman CR, Kepner J, Kun LE, Sanford RA, Kadota R, Mandell L, et al. A detrimental effect of a combined chemotherapy-radiotherapy approach in children with diffuse intrinsic brain stem gliomas? Int J Radiat Oncol Biol Phys 2000;47:561-4.
Kretschmar CS, Tarbell NJ, Barnes PD, Krischer JP, Burger PC, Kun L. Pre-irradiation chemotherapy and hyperfractionated radiation therapy 66 Gy for children with brain stem tumors. A phase II study of the Pediatric Oncology Group, Protocol 8833. Cancer 1993;72:1404-13.
Dunkel IJ, Garvin JH, Jr., Goldman S, Ettinger LJ, Kaplan AM, Cairo M, et al. High dose chemotherapy with autologous bone marrow rescue for children with diffuse pontine brain stem tumors. Children's Cancer Group. J Neurooncol 1998;37:67-73.
Bailey S, Howman A, Wheatley K, Wherton D, Boota N, Pizer B, et al. Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy – Results of a United Kingdom phase II trial (CNS 2007 04). European Journal of Cancer 2013;49:3856-62.
Bernier-Chastagner V, Grill J, Doz F, Bracard S, Gentet JC, Marie-Cardine A, et al. Topotecan as a radiosensitizer in the treatment of children with malignant diffuse brainstem gliomas: results of a French Society of Paediatric Oncology Phase II Study. Cancer 2005;104:2792-7.
Turner CD, Chi S, Marcus KJ, MacDonald T, Packer RJ, Poussaint TY, et al. Phase II study of thalidomide and radiation in children with newly diagnosed brain stem gliomas and glioblastoma multiforme. J Neurooncol 2007;82:95-101.
Doz F, Neuenschwander S, Bouffet E, Gentet JC, Schneider P, Kalifa C, et al. Carboplatin before and during radiation therapy for the treatment of malignant brain stem tumours: a study by the Societe Francaise d'Oncologie Pediatrique. Eur J Cancer 2002;38:815-9.
Frappaz D, Schell M, Thiesse P, Marec-Berard P, Mottolese C, Perol D, et al. Preradiation chemotherapy may improve survival in pediatric diffuse intrinsic brainstem gliomas: final results of BSG 98 prospective trial. Neuro Oncol 2008;10:599-607.
Massimino M, Biassoni V, Miceli R, Schiavello E, Warmuth-Metz M, Modena P, et al. Results of nimotuzumab and vinorelbine, radiation and re-irradiation for diffuse pontine glioma in childhood. J Neurooncol 2014;118:305-12.
Pollack IF, Jakacki RI, Butterfield LH, Hamilton RL, Panigrahy A, Potter DM, et al. Antigen-specific immune responses and clinical outcome after vaccination with glioma-associated antigen peptides and polyinosinic-polycytidylic acid stabilized by lysine and carboxymethylcellulose in children with newly diagnosed malignant brainstem and nonbrainstem gliomas. J Clin Oncol 2014;32:2050-8.
Grill J, Bhangoo R. Recent development in chemotherapy of paediatric brain tumours. Curr Opin Oncol 2007;19:612-5.
Jansen MH, van Vuurden DG, Vandertop WP, Kaspers GJ. Diffuse intrinsic pontine gliomas: a systematic update on clinical trials and biology. Cancer Treat Rev 2012;38:27-35.
Johnson KJ, Cullen J, Barnholtz-Sloan JS, Ostrom QT, Langer CE, Turner MC, et al. Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review. Cancer Epidemiol Biomarkers Prev 2014;23:2716-36.
Wolff JE, Rytting ME, Vats TS, Zage PE, Ater JL, Woo S, et al. Treatment of recurrent diffuse intrinsic pontine glioma: the MD Anderson Cancer Center experience. J Neurooncol 2012;106:391-7.
Broniscer A, Laningham FH, Sanders RP, Kun LE, Ellison DW, Gajjar A. Young age may predict a better outcome for children with diffuse pontine glioma. Cancer 2008;113:566-72.
Fontanilla HP, Pinnix CC, Ketonen LM, Woo SY, Vats TS, Rytting ME, et al. Palliative reirradiation for progressive diffuse intrinsic pontine glioma. Am J Clin Oncol 2012;35:51-7.
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2018-12-27
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นันทวิทยา ช. เนื้องอกสมองชนิด Diffuse Brain stem glioma (DIPG) ในผู้ป่วยเด็ก. J Thai Assn of Radiat Oncol [Internet]. 2018 Dec. 27 [cited 2024 Nov. 15];24(2):38-47. Available from: https://he01.tci-thaijo.org/index.php/jtaro/article/view/203028
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บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของวารสารมะเร็งวิวัฒน์ ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับ และบุคคลากรท่านอื่น ๆ ใน สมาคมฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใดๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
