Concurrent chemotherapy and low-dose craniospinal irradiation followed by conformal posterior fossa tumor bed boost for average risk medulloblastoma: efficacy and patterns of failure

2002 ◽  
Vol 54 (2) ◽  
pp. 149 ◽  
Author(s):  
J Douglas ◽  
J Barker ◽  
R Geyer ◽  
S Lindsley ◽  
R Ellenbogen
Keyword(s):  
Posterior Fossa ◽  
Low Dose ◽  
Concurrent Chemotherapy ◽  
Craniospinal Irradiation ◽  
Posterior Fossa Tumor ◽  
Average Risk ◽  
Patterns Of Failure ◽  
Tumor Bed ◽  
Tumor Bed Boost

Patterns of Failure Using a Conformal Radiation Therapy Tumor Bed Boost for Medulloblastoma

2003 ◽  
Vol 21 (16) ◽  
pp. 3079-3083 ◽  
Author(s):  
Suzanne L. Wolden ◽  
Ira J. Dunkel ◽  
Mark M. Souweidane ◽  
Laura Happersett ◽  
Yasmin Khakoo ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Posterior Fossa ◽  
Phase Iii ◽  
Cancer Center ◽  
High Dose ◽  
Patterns Of Failure ◽  
Female Ratio ◽  
Tumor Bed ◽  
Craniospinal Radiation ◽  
Tumor Bed Boost

Purpose: To assess the patterns of failure for patients with medulloblastoma receiving a conformal tumor bed boost rather than a boost to the entire posterior fossa. Patients and Methods: From 1994 to 2002, 32 consecutive patients with newly diagnosed medulloblastoma treated at Memorial Sloan-Kettering Cancer Center (New York, NY) received a conformal boost to the tumor bed in conjunction with craniospinal radiation therapy. Twenty-eight patients also received chemotherapy. The median age was 9 years (range, 3 to 34 years), and the male to female ratio was 3:1. Twenty-seven patients had standard-risk disease, and five patients had high-risk disease. Craniospinal doses ranged from 23.4 to 39.6 Gy, and total tumor bed doses ranged from 54 to 59.4 Gy. Results: With a median follow-up of 56 months, six patients have relapsed; five relapsed outside of the posterior fossa, and one failed within the posterior fossa, outside of the high-dose boost volume. Five-year actuarial disease-free and overall survival rates were 84% and 85%, respectively. Freedom from posterior fossa failure was 100% and 86% at 5 and 10 years, respectively. Freedom from distant failure was 84% at 5 years, with a trend for improvement when full-dose craniospinal radiation (36 to 39.6 Gy) was used compared with a reduced dose (23.4 Gy) of radiation (100% v 63%, respectively; P = .06). No other predictive variables were identified. Conclusion: Conformal treatment to the tumor bed allows for significant sparing of critical structures. The posterior fossa failure rate in this series is similar to that reported when the entire posterior fossa is treated. This approach should be investigated further in a phase III trial.

scholarly journals Phase II Trial of Response-Based Radiation Therapy for Patients With Localized CNS Nongerminomatous Germ Cell Tumors: A Children's Oncology Group Study

2019 ◽  
Vol 37 (34) ◽  
pp. 3283-3290 ◽  
Author(s):  
Jason Fangusaro ◽  
Shengjie Wu ◽  
Shannon MacDonald ◽  
Erin Murphy ◽  
Dennis Shaw ◽  
...  
Keyword(s):  
Germ Cell ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Germ Cell Tumors ◽  
Primary Objective ◽  
Craniospinal Irradiation ◽  
Oncology Group ◽  
Tumor Bed ◽  
Tumor Bed Boost ◽  
The Impact

PURPOSE Stratum 1 of ACNS1123 (ClinicalTrials.gov identifier: NCT01602666 ), a Children’s Oncology Group phase II trial, evaluated efficacy of reduced-dose and volume of radiotherapy (RT) in children and adolescents with localized nongerminomatous germ cell tumors (NGGCTs). The primary objective was to evaluate the impact of reduced RT on progression-free survival (PFS) with a goal of preserving neurocognitive function. PATIENTS AND METHODS Patients received six cycles of chemotherapy with carboplatin and etoposide alternating with ifosfamide and etoposide, as used in the Children’s Oncology Group predecessor study (ACNS0122; ClinicalTrials.gov identifier: NCT00047320 ). Patients who achieved a complete response (CR) or partial response (PR) with or without second-look surgery were eligible for reduced RT, defined as 30.6 Gy whole ventricular field and 54 Gy tumor-bed boost, compared with 36 Gy craniospinal irradiation plus 54 Gy tumor-bed boost used in ACNS0122. RESULTS A total of 107 eligible patients were enrolled. Median age was 10.98 years (range, 3.68 to 21.63) and 75% were male. Sixty-six of 107 (61.7%) achieved a CR or PR and proceeded to reduced RT. The 3-year PFS and overall survival and standard error values were 87.8% ± 4.04% and 92.4% ± 3.3% compared with 92% and 94.1%, respectively, in ACNS0122. There were 10 recurrences, prompting early study closure; however, after a retrospective central review, only disease in eight of 66 (12.1%) patients eligible for reduced RT subsequently progressed; six patients had distant spinal relapse alone and two had disease with combined local plus distant relapse. Serum and CSF α-fetoprotein and β-human chorionic gonadotropin levels were not associated with PFS. CONCLUSION Patients with localized NGGCT who achieved a CR or PR to chemotherapy and received reduced RT had encouraging PFS similar to patients in ACNS0122 who received full-dose craniospinal irradiation. However, the patterns of failure were distinct, with all patients having treatment failure in the spine.

scholarly journals Vulnerability of white matter to insult during childhood: evidence from patients treated for medulloblastoma

2016 ◽  
Vol 18 (1) ◽  
pp. 29-40 ◽  
Author(s):  
Iska Moxon-Emre ◽  
Eric Bouffet ◽  
Michael D. Taylor ◽  
Normand Laperriere ◽  
Michael B. Sharpe ◽  
...  
Keyword(s):  
White Matter ◽  
Fractional Anisotropy ◽  
Standard Dose ◽  
Brain Regions ◽  
Craniospinal Irradiation ◽  
Temporal Region ◽  
Radial Diffusivity ◽  
Tumor Bed ◽  
Reduced Dose ◽  
Tumor Bed Boost

OBJECTIVE Craniospinal irradiation damages the white matter in children treated for medulloblastoma, but the treatment-intensity effects are unclear. In a cross-sectional retrospective study, the effects of treatment with the least intensive radiation protocol versus protocols that delivered more radiation to the brain, in addition to the effects of continuous radiation dose, on white matter architecture were evaluated. METHODS Diffusion tensor imaging was used to assess fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity. First, regional white matter analyses and tract-based spatial statistics were conducted in 34 medulloblastoma patients and 38 healthy controls. Patients were stratified according to those treated with 1) the least intensive radiation protocol, specifically reduced-dose craniospinal irradiation plus a boost to the tumor bed only (n = 17), or 2) any other dose and boost combination that delivered more radiation to the brain, which was also termed the “all-other-treatments” group (n = 17), and comprised patients treated with standard-dose craniospinal irradiation plus a posterior fossa boost, standard-dose craniospinal irradiation plus a tumor bed boost, or reduced-dose craniospinal irradiation plus a posterior fossa boost. Second, voxel-wise dose-distribution analyses were conducted on a separate cohort of medulloblastoma patients (n = 15). RESULTS The all-other-treatments group, but not the reduced-dose craniospinal irradiation plus tumor bed group, had lower fractional anisotropy and higher radial diffusivity than controls in all brain regions (all p < 0.05). The reduced-dose craniospinal irradiation plus tumor bed boost group had higher fractional anisotropy (p = 0.05) and lower radial diffusivity (p = 0.04) in the temporal region, and higher fractional anisotropy in the frontal region (p = 0.04), than the all-other-treatments group. Linear mixed-effects modeling revealed that the dose and age at diagnosis together 1) better predicted fractional anisotropy in the temporal region than models with either alone (p < 0.005), but 2) did not better predict fractional anisotropy in comparison with dose alone in the occipital region (p > 0.05). CONCLUSIONS Together, the results show that white matter damage has a clear association with increasing radiation dose, and that treatment with reduced-dose craniospinal irradiation plus tumor bed boost appears to preserve white matter in some brain regions.

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