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Outcomes of salvage re-irradiation in recurrent medulloblastoma correlate with age at initial diagnosis, primary risk-stratification, and molecular subgrouping

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Abstract

Purpose

To report outcomes of salvage re-irradiation (re-RT) in recurrent/progressive medulloblastoma (MB).

Methods

Medical records of patients treated with curative-intent re-RT as multi-modality management for recurrent/progressive MB between 2008 and 2018 were analyzed retrospectively.

Results

A total of 28 patients (median age 18 years at index diagnosis) were included. Molecular subgrouping was done using real-time reverse transcriptase polymerase chain reaction (RT-PCR) based on the differential expression of select set of 12 protein coding genes and 9 microRNAs. Fifteen of 17 (88%) patients with sonic hedgehog (SHH)-MB developed isolated local recurrence within the index tumor-bed, while 5 of 7 (72%) patients with Group 4 MB developed localized relapse outside the posterior fossa. Diffuse neuraxial dissemination was seen in 2 patients with SHH-MB, and one each of Group 4 and wingless (WNT)-MB. Molecular subgrouping was not known in 3 patients. The dose and volume of re-RT was based on site and patterns of relapse, comprising unifocal in 18 (64%), multi-focal in 3 (11%), and repeat craniospinal irradiation (re-CSI) in 7 (25%) patients. Median interval from primary irradiation to re-RT was 49.5 months (range 24–98 months) with median cumulative biologically effective dose of 117 Gy (range 78–132 Gy). All patients received platinum-based salvage chemotherapy either before or after re-RT. One patient developed symptomatic radiation necrosis following re-CSI. At a median follow-up of 24 months (range 6–84 months), 2-year post-re-RT progression-free survival (PFS) and overall survival (OS) was 46% and 51% respectively. Younger age (< 18 years) at index diagnosis, primary risk stratification (standard-risk) and molecular subgrouping (Group 4) were associated with significantly better post-re-RT outcomes.

Conclusion

Salvage re-RT provides good local control and encouraging survival outcomes with acceptable toxicity in selected patients with recurrent/progressive MB.

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Funding

No source of funding was involved in this retrospective study.

Author information

Authors and Affiliations

  1. Departments of Radiation Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India

    Tejpal Gupta, Madan Maitre, Goda Jayant Sastri & Rahul Krishnatry

  2. Departments of Neuro-Oncology Lab, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Neelam Shirsat

  3. Departments of Pathology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Sridhar Epari & Ayushi Sahay

  4. Departments of Pediatric Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Girish Chinnaswamy

  5. Departments of Medical Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Vijay Patil

  6. Departments of Neurosurgical Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Prakash Shetty & Aliasgar Moiyadi

Authors
  1. Tejpal Gupta
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  2. Madan Maitre
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  3. Goda Jayant Sastri
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  8. Girish Chinnaswamy
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  9. Vijay Patil
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Correspondence to Tejpal Gupta.

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11060_2019_3225_MOESM1_ESM.png

Supplementary material 1 (PNG 96 kb) Figure S2: Kaplan-Meier curves of post-re-irradiation progression-free survival (a) and overall survival (b) for the study cohort stratified by extent of re-irradiation (unifocal vs multi-focal vs craniospinal re-irradiation)

Supplementary material 2 (DOCX 26 kb)

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Gupta, T., Maitre, M., Sastri, G.J. et al. Outcomes of salvage re-irradiation in recurrent medulloblastoma correlate with age at initial diagnosis, primary risk-stratification, and molecular subgrouping. J Neurooncol 144, 283–291 (2019). https://doi.org/10.1007/s11060-019-03225-9

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  • DOI: https://doi.org/10.1007/s11060-019-03225-9

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