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



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.


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.


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.


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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Author information




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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Liu, IC., Holtzman, A.L., Rotondo, R.L. et al. Proton therapy for adult medulloblastoma: Acute toxicity and disease control outcomes. J Neurooncol (2021).

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