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Helical tomotherapy-based craniospinal irradiation: mature outcomes of a prospective feasibility study

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The objective of the study was to report mature outcomes in patients treated on a prospective feasibility study of helical tomotherapy-based craniospinal irradiation.

Methods

Patients needing craniospinal irradiation were accrued, treated, and followed up longitudinally for survival and toxicity on an institutional review board-approved study.

Results

Twenty patients (median age of 15 years) constituted the study cohort. Tomotherapy-based craniospinal irradiation was well tolerated with self-limiting and reversible acute toxicity. Four (20 %) patients needed growth factor or platelet support during craniospinal irradiation. Significant late neuro-toxicity was seen in only one (5 %) patient. None of the patients developed symptomatic radiation pneumonitis or second new malignancy. At a median follow-up of 62 months (inter-quartile range 24–71 months), the 5-year progression-free survival and overall survival for the entire cohort was 50 and 55 %, respectively. Outcomes within the cohort varied significantly; patients with favorable biology disease had good outcomes while patients with high-risk, metastatic, or recurrent disease fared poorly reflecting inherently aggressive biology.

Conclusions

Helical tomotherapy is an ideal platform for planning, verification, and delivery of supine craniospinal irradiation in clinical practice resulting in moderate, self-limiting, reversible acute toxicity and modest delayed toxicity. Patterns of failure and survival outcomes are largely dependent upon disease biology and are not any different compared to conventional techniques.

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Authors and Affiliations

  1. Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India

    Tejpal Gupta, Bhooshan Zade, Mahesh Upasani, Godajayant Sastri & Rakesh Jalali

  2. Department of Medical Physics, ACTREC/TMH, Tata Memorial Centre, Parel, Mumbai, 400012, India

    Zubin Master & Reena Phurailatpam

  3. Department of Pediatric Oncology, ACTREC/TMH, Tata Memorial Centre, Parel, Mumbai, 400012, India

    Purna Kurkure

  4. Department of Medical Oncology, ACTREC/TMH, Tata Memorial Centre, Parel, Mumbai, 400012, India

    Hari Menon

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  1. Tejpal Gupta
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Correspondence to Tejpal Gupta.

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Funding

This study was partially funded by a competitive intramural research grant (IRB Project No. 197) provided by Tata Memorial Centre, Mumbai.

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and consent to participate

This study was duly approved by the Institutional Ethics Committee of Tata Memorial Centre, Mumbai. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all patients included in the study.

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Gupta, T., Zade, B., Upasani, M. et al. Helical tomotherapy-based craniospinal irradiation: mature outcomes of a prospective feasibility study. J Radiat Oncol 5, 221–230 (2016). https://doi.org/10.1007/s13566-015-0235-2

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