BACKGROUND: Overall survival (OS) of patients with diffuse intrinsic pontine 
glioma (DIPG) is poor, with radiation therapy (RT) the only intervention that 
transiently delays tumor progression. Hypofractionated RT and re-irradiation at 
first progression have gained popularity in improving the quality of life of 
such patients.
METHODS: We performed a retrospective review of children with DIPG treated at 
Kanagawa Children's Medical Center from 2000 to 2018.
RESULTS: A total of 24 cases were reviewed. Median age at diagnosis was 
6.3 years (1.6-14.0). Twenty patients received RT only once. Thirteen patients 
received conventionally fractionated RT, and seven patients received 
hypofractionated RT as up-front RT. Severe toxicities were not observed in 
patients who received hypofractionated RT. Median OS and time to progression 
were similar between conventionally fractionated and hypofractionated RT 
groups.(9.7 [95% confidence interval(CI): 7.1-11.2] versus 11.0[95% CI: 
5.2-13.6] months, P = 0.60; 4.2[95% CI: 1.8-8.3] versus 7.1 [95% CI:4.5-8.7] 
months, P = 0.38). Four patients received re-irradiation at first progression 
and all patients showed transient neurological improvement and survival more 
than a year after diagnosis. A 4-year-old boy was re-irradiated 5-and-a-half 
months after the first re-irradiation; following transient neurological 
improvement. He survived a further 5 months.
CONCLUSION: Hypofractionated RT for children with newly diagnosed DIPG is well 
tolerated and feasible from the viewpoint of reducing a patient's burden of 
treatment. Re-irradiation at first progression is suggested to be beneficial.