Proton therapy for adult medulloblastoma: Acute toxicity and disease control outcomes

Abstract

Purpose

We report disease control, survival outcomes, and treatment-related toxicity among adult medulloblastoma patients who received proton craniospinal irradiation (CSI) as part of multimodality therapy.

Methods

We reviewed 20 adults with medulloblastoma (≥ 22 years old) who received postoperative proton CSI ± chemotherapy between 2008 and 2020. Patient, disease, and treatment details and prospectively obtained patient-reported acute CSI toxicities were collected. Acute hematologic data were analyzed.

Results

Median age at diagnosis was 27 years; 45% of patients had high-risk disease; 75% received chemotherapy, most (65%) after CSI. Eight (40%) patients received concurrent vincristine with radiotherapy. Median CSI dose was 36GyE with a median tumor bed boost of 54GyE. Median duration of radiotherapy was 44 days. No acute ≥ grade 3 gastrointestinal or hematologic toxicities attributable to CSI occurred. Grade 2 nausea and vomiting affected 25% and 5% of patients, respectively, while 36% developed acute grade 2 hematologic toxicity (36% grade 2 leukopenia and 7% grade 2 neutropenia). Those receiving concurrent chemotherapy with CSI had a 38% rate of grade 2 hematologic toxicity compared to 33% among those not receiving concurrent chemotherapy. Among patients receiving adjuvant chemotherapy (n = 13), 100% completed ≥ 4 cycles and 85% completed all planned cycles. With a median follow-up of 3.1 years, 4-year actuarial local control, disease-free survival, and overall survival rates were 90%, 90%, and 95%, respectively.

Conclusions

Proton CSI in adult medulloblastoma patients is very well tolerated and shows promising disease control and survival outcomes. These data support the standard use of proton CSI for adult medulloblastoma.

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Data Availability

The authors agree to share anonymized data upon reasonable request by researchers.

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Funding

The authors did not receive any funding, grants, or other support for the submitted work.

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Contributions

I-Chia Liu, MD: investigation; writing-original draft; writing-review & editing. Adam L. Holzman, MD: writing-review & editing. Ronny L. Rotondo, MD: writing-review & editing. Daniel J. Indelicato, MD: writing-review & editing. Sridharan Gururangan, FRCP (Edin): writing-review & editing. Robert Cavaliere, MD: writing-review & editing. Bridgette Carter, CMD: writing-review & editing. Christopher G. Morris, MS: methodology; formal analysis; validation; writing-review & editing. Daryoush Tavanaiepour, MBChB (MD): writing-review & editing. Michael S. Rutenberg, MD, PhD: conceptualization; methodology; validation; resources; writing-review & editing; supervision; project administration.

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Correspondence to Michael S. Rutenberg.

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This retrospective study was approved by the University of Florida Institutional Review Board.

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Liu, IC., Holtzman, A.L., Rotondo, R.L. et al. Proton therapy for adult medulloblastoma: Acute toxicity and disease control outcomes. J Neurooncol (2021). https://doi.org/10.1007/s11060-021-03783-x

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Keywords

  • Craniospinal irradiation
  • Radiation therapy
  • Particle therapy
  • Central nervous system tumors
  • Clinical outcomes