Overall survival and secondary malignant neoplasms in children receiving passively scattered proton or photon craniospinal irradiation for medulloblastoma

✓ A 28-year-old man presented to the authors' hospital with multiple intracranial tumors. At 2 years of age, he had undergone resection of a medulloblastoma and received adjunctive craniospinal irradiation. Subsequently, he was diagnosed with nevoid basal cell carcinoma syndrome, Gorlin's syndrome. Since his first presentation, he has required surgery for multiple basal cell carcinomas, an osteochondroma of the rib, two meningiomas, a trigeminal schwannoma, and a pleomorphic liposarcoma, all of which arose within the radiation field. Despite this impressive list of benign and malignant neoplasms, the patient is relatively well and leads a normal life. The authors examine the relationships between Gorlin's syndrome and radiation therapy and the subsequent development of tumors.

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Secondary or Concomitant Neoplasms among Adults Diagnosed with Acute Lymphoblastic Leukemia (ALL) and Treated According to the LALA-87 and LALA-94 Trials.

Blood ◽

10.1182/blood.v106.11.1826.1826 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1826-1826

Author(s):

Emmanuelle Tavernier ◽

Stephane de Botton ◽

Nathalie Dhedin ◽

Claude-Eric Bulabois ◽

Oumedaly Reman ◽

...

Keyword(s):

Overall Survival ◽

Lymphoblastic Leukemia ◽

Cumulative Risk ◽

Malignant Neoplasm ◽

Malignant Neoplasms ◽

Secondary Neoplasms ◽

Childhood All ◽

Second Neoplasms ◽

Acute Myeloid

Abstract Second malignant neoplasms are a serious complication after successful treatment of childhood ALL. Although treatment intensity and outcome were not comparable, with improvements in survival, it is important to evaluate the rate and the type of second neoplasms in adults with ALL. We analyzed the data from the GET-LALA group. A cohort of 1493 patients, aged 15 to 60 years and enrolled on two successive multicenter protocols between 1987 and 2002, was observed to determine the incidence of second neoplasms and associated risk factors. The median follow-up time from diagnosis was 6 years. By February 2005, secondary or concomitant neoplasms were documented in 23 patients (median age: 36 years, range:18–57) including 9 acute myeloid leukemias, 4 non Hodgkin lymphomas, 5 skin tumors, and 5 other solid tumors (1 lung cancer, 1 tongue carcinoma, 1 thymoma, 1 condrosarcoma, 1 histiocytosis). Neoplasms developed 0.5 to 13.8 years (median, 4.5 years) after the diagnosis of ALL. 22 patients were in first remission, one was in second remission. The overall cumulative risk of secondary neoplasms was 2.1% at 5 years, 4.9% at 10 years, 9.4% at 15 years. The cumulative risk of developing a second hematologic malignancy was 1.8% at 5 years, 2.2% at 10 years, 3.3% at 18 years; that of developing a solid tumor was 0.2% at 5 years, 2.8% at 10 years, 6.2% at 15 years. The development of secondary neoplasm was not associated with the use of any specific cytotoxic agent. However, risk of skin tumor increased with radiation dose and transplantation (p = 0.01). Overall survival after the diagnosis of a second malignant neoplasm was 55% at 10 years. However, the median overall survival in patients developing acute myeloid leukemia was of 5.7 months. Considering the low-survival rate of this large unselected adult ALL cohort (32% at 10 years), considering the poorer results comparing to childhood ALL treatment, the risk of secondary or concomitant neoplasm remains probably under estimated. Larger series with long-term follow-up are, however, mandatory. Figure Figure

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Assessment of the results and the haematologic side effects of the 3D conformal and the IMRT/ARC therapies delivered during the craniospinal irradiation of childhood tumors, in a follow-up period of 5 years

10.21203/rs.2.22830/v1 ◽

2020 ◽

Author(s):

Zoltán Lőcsei ◽

Róbert Farkas ◽

Kornélia Borbásné Farkas ◽

Klára Sebestyén ◽

Zsolt Sebestyén ◽

...

Keyword(s):

Overall Survival ◽

Side Effects ◽

Survival Data ◽

Organs At Risk ◽

Progression Free Survival ◽

Craniospinal Irradiation ◽

Free Survival ◽

Laboratory Parameters ◽

Childhood Tumors

Abstract Objectives The craniospinal irradiation (CSI) of childhood tumors with Rapidarc technique is a new way of treatment. Our objective was to compare the acute haematologic toxicity pattern during 3D conformal radiotherapy with the application of the novel techniques. Materials and methods Data from patients treated between 2007 and 2014 has been collected and seven patients were identified in each of both treatment groups. The acute blood toxicity results were obtained, after establishing a general linear model, by using the SPSS software. Furthermore, the dose exposure of the organs-at-risk has been compared. Patients have been followed-up for a minimum of five years, then progression-free survival and overall survival data were assessed. Results After the assessment of the laboratory parameters of the two groups, it may be concluded that no significant differences were detected in terms of the mean dose exposures of the normal tissues or the acute hematological side-effects during the IMRT/ARC and the 3D conformal treatment. Laboratory parameters significantly decreased compared to the baseline values during the treatment weeks. Nevertheless, no significant differences were detected between the two groups. No remarkable differences were confirmed between the two groups regarding the five-year progression-free survival and overall survival, and no signs of serious irradiation organ toxicity were observed during the follow-up period in either of the groups. Conclusion Rapidarc technique can be used safely even for the treatment of childhood tumors, as the extent of normal tissue dose exposures and that of acute hematological side effects is not higher.

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A Monte Carlo‐based analytic model of neutron dose equivalent for a mevion gantry‐mounted passively scattered proton system for craniospinal irradiation

Medical Physics ◽

10.1002/mp.14299 ◽

2020 ◽

Vol 47 (9) ◽

pp. 4509-4521

Author(s):

Milad Baradaran‐Ghahfarokhi ◽

Francisco Reynoso ◽

Baozhou Sun ◽

Arash Darafsheh ◽

Michael T. Prusator ◽

...

Keyword(s):

Monte Carlo ◽

Neutron Dose ◽

Craniospinal Irradiation ◽

Analytic Model ◽

Dose Equivalent ◽

Scattered Proton ◽

Neutron Dose Equivalent

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A Pilot Study of Low-Dose Craniospinal Irradiation in Patients With Newly Diagnosed Average-Risk Medulloblastoma

Frontiers in Oncology ◽

10.3389/fonc.2021.744739 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jane E. Minturn ◽

Aaron Y. Mochizuki ◽

Sonia Partap ◽

Jean B. Belasco ◽

Beverly J. Lange ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Craniospinal Irradiation ◽

Treatment Modalities ◽

Average Risk ◽

Clinical Trial Registration ◽

Craniospinal Radiation ◽

Grade 5 ◽

Effects Of Radiation ◽

Therapy Studies

PurposeMedulloblastoma is one of the most common malignant brain tumors in children. To date, the treatment of average-risk (non-metastatic, completely resected) medulloblastoma includes craniospinal radiation therapy and adjuvant chemotherapy. Modern treatment modalities and now risk stratification of subgroups have extended the survival of these patients, exposing the long-term morbidities associated with radiation therapy. Prior to advances in molecular subgrouping, we sought to reduce the late effects of radiation in patients with average-risk medulloblastoma.MethodsWe performed a single-arm, multi-institution study, reducing the dose of craniospinal irradiation by 25% to 18 Gray (Gy) with the goal of maintaining the therapeutic efficacy as described in CCG 9892 with maintenance chemotherapy.ResultsTwenty-eight (28) patients aged 3-30 years were enrolled across three institutions between April 2001 and December 2010. Median age at enrollment was 9 years with a median follow-up time of 11.7 years. The 3-year relapse-free (RFS) and overall survival (OS) were 79% (95% confidence interval [CI] 58% to 90%) and 93% (95% CI 74% to 98%), respectively. The 5-year RFS and OS were 71% (95% CI 50% to 85%) and 86% (95% CI 66% to 94%), respectively. Toxicities were similar to those seen in other studies; there were no grade 5 toxicities.ConclusionsGiven the known neurocognitive adverse effects associated with cranial radiation therapy, studies to evaluate the feasibility of dose reduction are needed. In this study, we demonstrate that select patients with average-risk medulloblastoma may benefit from a reduced craniospinal radiation dose of 18 Gy without impacting relapse-free or overall survival.Clinical Trial RegistrationClinicalTrials.gov identifier: NCT00031590

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Factors associated with surgical resection for pancreatic and periampullary carcinomas in a cancer center in Mexico City.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.191 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 191-191

Author(s):

Luis F. Onate-Ocana ◽

Elyzabeth Bermudez-Benitez ◽

Miguel Angel Ortiz-Toledo ◽

Francisco J. Ochoa-Carrillo ◽

Vincenzo Aiello-Crocifoglio

Keyword(s):

Overall Survival ◽

Surgical Resection ◽

Cox Model ◽

Ampullary Carcinoma ◽

Cancer Center ◽

Neuroendocrine Neoplasms ◽

Malignant Neoplasms ◽

Factors Associated ◽

Periampullary Neoplasms ◽

Periampullary Region

191 Background: Medical information regarding periampullary neoplasms is scarce in Mexico. Therefore, our aim is to report our experience with pancreatic and periampullary neoplasms, with attention to factors associated to surgical resection in a Cancer Center. Methods: A retrospective analysis of medical records of all patients with malignant neoplasms located at periampullary region demonstrated by biopsy from January 2005 to December 2010. Factors associated to resectability or survival were calculated employing logistic regression or Cox models. Results: A total of 464 patients with neoplasms of the periampullary region were identified, 249 women and 215 males (mean age 60.2 years). Pancreatic cancer was reported in 269 cases (58%), ampullary in 91 (19.6%), duodenal in 63 (13.6%), intrapancreatic bile duct in 15 (3.2%), neuroendocrine neoplasms in 13 (2.8%) and other types in 13 (2.8%). Sixty-two pancreatoduodenectomies were performed in this 6-year period (13.4% resectability). Sixty-one patients were stages I or II, and 403 stages III or IV. Age (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.96-0.99) and ampullary carcinoma (OR 6.09; 95% CI 3.4-10.8) were the only factors associated to resectability (p<0.0001). Median overall survival of the cohort was 2.9 months (95% CI 2.4-3.4). Factors associated to overall survival with their estimators of the Cox model (p<0.00001) are shown in the Table. Conclusions: Resectability is low and advanced stages are frequent. Young age and location in the ampulla defines increased probability of resection. Overall survival is associated to younger age, being female, ampullary carcinoma, neuroendocrine carcinoma and surgical resection. [Table: see text]

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PO-0833: Measured neutron spectra & dose: craniospinal irradiation on single-room passively scattered proton

Radiotherapy and Oncology ◽

10.1016/s0167-8140(16)32083-7 ◽

2016 ◽

Vol 119 ◽

pp. S394-S395

Author(s):

R. Howell ◽

E.A. Burgett ◽

D. Isaccs ◽

S.G. Price Hedrick ◽

M.P. Reilly ◽

...

Keyword(s):

Craniospinal Irradiation ◽

Neutron Spectra ◽

Scattered Proton ◽

Single Room

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Incidence, Management, and Outcomes of Adult Spinal Chordoma Patients in the United States

Global Spine Journal ◽

10.1177/2192568221995155 ◽

2021 ◽

pp. 219256822199515

Author(s):

Saavan Patel ◽

Ravi S. Nunna ◽

James Nie ◽

Darius Ansari ◽

Nauman S. Chaudhry ◽

...

Keyword(s):

Overall Survival ◽

Surgical Resection ◽

Radical Resection ◽

The United States ◽

Treatment Modalities ◽

Malignant Neoplasms ◽

En Bloc ◽

Chemotherapy Administration ◽

Spinal Chordoma ◽

Diagnosis Codes

Study Design: Retrospective cohort study. Objective: Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment. Gold standard treatment remains en-bloc surgical resection with questionable efficacy of adjuvant therapies such as radiation and chemotherapy. Here we provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chordoma. Methods: Patients with diagnosis codes specific for chordoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. Results: 1,548 individuals were identified with a diagnosis of chordoma, 60.9% of which were at the sacrum or coccyx and 39.1% at the spine. The mean overall survival of patients in our cohort was 8.2 years. Increased age, larger tumor size, and presence of metastases were associated with worsened overall survival. 71.2% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival ( P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received proton-based radiation had significantly improved overall survival compared to traditional radiation. Conclusion: Surgical resection significantly improves overall survival in patients with spinal chordoma. In those patients receiving radiation, those who receive proton-based modalities have improved overall survival. Further studies into proton radiotherapy doses are required.

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Measured Neutron Spectra and Dose Equivalents From a Mevion Single-Room, Passively Scattered Proton System Used for Craniospinal Irradiation

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.12.356 ◽

2016 ◽

Vol 95 (1) ◽

pp. 249-257 ◽

Cited By ~ 10

Author(s):

Rebecca M. Howell ◽

Eric A. Burgett ◽

Daniel Isaacs ◽

Samantha G. Price Hedrick ◽

Michael P. Reilly ◽

...

Keyword(s):

Craniospinal Irradiation ◽

Neutron Spectra ◽

Scattered Proton ◽

Single Room

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Propensity score matching analysis of ovarian cancer patients with multiple primary malignant neoplasms using multicenter real-world data.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17501 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17501-e17501

Author(s):

Qing-lei Gao ◽

Xiaofei Jiao ◽

Ruyuan Li ◽

Shaoqing Zeng ◽

Yingjun Zhao ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Overall Survival ◽

Propensity Score ◽

Propensity Score Matching ◽

Cancer Patients ◽

Cox Regression ◽

Malignant Neoplasms ◽

Cox Regression Analysis ◽

Multiple Primary

e17501 Background: Multiple primary malignant neoplasms (MPMNs) in patients with ovarian cancer is rare and has not attracted enough attention. It is unclear how the MPMNs affect the prognosis of ovarian cancer (OC) patients. Methods: This is a multicenter retrospective analysis of 5, 268 ovarian cancer patients from six centers who was diagnosed with ovarian cancer from January 1, 1989 to August 21, 2020. Propensity score matching was used to balance the baseline characteristics between patients with and without MPMNs. Cox regression analysis was utilized to analyze the influence of MPMNs on overall survival (OS). Results: After excluding unqualified medical record, totally 4, 848 patients were analyzed and 240 were concurrent at least one MPMNs other than OC. Ten patients had two MPMNs and one patient had three. The most common concurrent cancer was breast cancer (111/240, 46.25%), followed by endometrial cancer (37/240, 15.42%), and cervical cancer (30/240, 12.50%). Patients with MPMNs were elder than those without MPMNs (52 vs. 51, P = 0.03) when ovarian cancer was diagnosed. And the proportion of early-stage cases was lower in patients with MPMNs (25.8% vs. 27.2%, P < 0.001). Patients with breast cancer had a higher proportion of high-grade serous ovarian cancer (HGSOC) than those without MPMNs. After using the propensity score matching method adjusting age, pathological type, grade, and stage, concurrent MPMNs, including breast cancer, had no effect on OS of ovarian cancer patients. Among 240 patients with MPMNs, patients with breast cancer shared similar age and stage compared with the rest patients, while their proportion of HGSOC was higher than patients with other cancer (68.4% vs. 51.1%, P = 0.028). However, the median OS of those two groups were similar (27.3 m vs.27.1 m, P = 0.744). In addition, 94 patients were diagnosed with breast cancer prior to ovarian cancer, seven diagnosed posteriorly to ovarian cancer, four diagnosed simultaneously, and six had no precise diagnosed dates. There was no remarkable difference in clinical characteristics between the prior and posterior groups, however, the median OS of those seven patients was significantly longer than the prior group (76.0 m vs. 25.4 m, P = 0.002). Conclusions: The MPMNs showed no influence on the overall survival of ovarian cancer patients. The order of diagnosis of ovarian cancer and breast cancer might affect the prognosis.

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