Abstract
Purpose
The objective of this study is to evaluate the tolerability and outcome of craniospinal irradiation (CSI) with helical tomotherapy (HT) in the treatment of medulloblastoma.
Methods
We evaluated 19 consecutive patients with primary medulloblastoma who were treated with HT from 2007 through 2010. HT regimens to the neuroaxis included: 23.4 Gy at 1.8 Gy/fraction (N = 10), 36 Gy at 1.8 Gy/fraction (N = 7), and 39 Gy bid at 1.3 Gy/fraction (N = 2). The tumor bed received 54–60 Gy. Potential associations between patient, treatment, and toxicity factors and overall survival (OS) were assessed in univariate analyses using the Cox proportional hazards model. Spearman’s rank correlation coefficient was used to correlate potential risk factors with the grade of acute toxicity.
Results
The median age at diagnosis was 5 years (range 2–14) and the median follow-up for alive patients (N = 14) 40 months (range 10–62). Two- and three-year overall survival was 75 and 68 %, respectively. The most common acute toxicity was hematological (79 %), being grade 2 and grade 3 in 4 (21 %) and 11 (58 %) cases, respectively. No grade ≥2 late toxicities were observed. Higher grades of acute body toxicity were found in older children (P = 0.004). Longer time between diagnosis and radiation therapy was correlated with shorter OS (P = 0.03). In addition, higher grades of acute thrombocytopenia were associated with shorter OS (P = 0.03).
Conclusions
CSI delivered with HT for medulloblastoma is well tolerated with low rates of severe acute toxicity. Further research is necessary to assess late toxicity with a longer follow-up.
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References
Kaderali Z, Lamberti-Pasculli M, Rutka JT. The changing epidemiology of paediatric brain tumours: a review from the Hospital for Sick Children. Childs Nerv Syst. 2009;25:787–93.
Navajas A, Giralt J. Evidence in medulloblastomas. Clin Transl Oncol. 2010;12:271–7.
Roussos I, Balañá C, Cuadras P, Ballester R, Etxaniz O, Hostalot C. Medulloblastoma in young adults. Must we give adjuvant chemotherapy? Clin Transl Oncol. 2007;9:121–3.
Sharma DS, Gupta T, Jalali R, Master Z, Phurailatpam RD, Sarin R. High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy. Br J Radiol. 2009;82:1000–9.
Jones B, Wilson P, Nagano A, Fenwick J, McKenna G. Dilemmas concerning dose distribution and the influence of relative biological effect in proton beam therapy of meduloblastoma. Br J Radiol. 2012;85:e912–8.
Teoh M, Clark CH, Wood K, Whitaker S, Nisbet A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. 2001;84:967–96.
Hong JY, Kim GW, Kim CU, Cheon GS, Son SH, Lee JY, et al. Supine linac treatment versus tomotherapy in craniospinal irradiation: planning comparison and dosimetric evaluation. Radiat Prot Dosim. 2011;146:364–6.
Sugie C, Shibamoto Y, Ayakawa S, Mimura M, Komai K, Ishii M, et al. Craniospinal irradiation using helical tomotherapy: evaluation of acute toxicity and dose distribution. Technol Cancer Res Treat. 2011;10:187–95.
Polkinghorn WR, Tarbell NJ. Medulloblastoma: tumorigenesis, current clinical paradigm, and efforts to improve risk stratification. Nat Clin Pract Oncol. 2007;4:295–304.
Mesbah L, Matute R, Usychkin S, Marrone I, Puebla F, Mínguez C, et al. Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity. Radiat Oncol. 2011;6:102.
International Commission on Radiation Units and Measurements. ICRU report 62: Prescribing, recording, and reporting photon beam therapy (Supplement to ICRU report 50) Bethesda, Maryland, USA; 1999
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.
Ashley DM, Merchant TE, Strother D, Zhou T, Duffner P, Burger PC, et al. Induction chemotherapy and conformal radiation therapy for very young children with nonmetastatic medulloblastoma: Children’s Oncology Group study P9934. J Clin Oncol. 2012;30:3181–6.
Rieken S, Mohr A, Habermehl D, Welzel T, Lindel K, Witt O, et al. Outcome and prognostic factors of radiation therapy for medulloblastoma. Int J Radiat Oncol Biol Phys. 2011;81:e7–13.
Nieder C, Haukland E, Pawinski A, Dalhaug A. Anemia and thrombocytopenia in patients with prostate cancer and bone metastases. BMC Cancer. 2010;10:284.
Rocconi RP, Matthews KS, Kemper M, Hoskins K, Barnes MN. Chemotherapy-related myelosuppression as a marker of survival in epithelial ovarian cancer patients. Gynecol Oncol. 2008;108:336–41.
Harron E, Lewis J. Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method. Med Dosim. 2012;37:140–4.
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The authors had no conflict of interests with regard to this study.
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Lopez Guerra, J.L., Marrone, I., Jaen, J. et al. Outcome and toxicity using helical tomotherapy for craniospinal irradiation in pediatric medulloblastoma. Clin Transl Oncol 16, 96–101 (2014). https://doi.org/10.1007/s12094-013-1048-7
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DOI: https://doi.org/10.1007/s12094-013-1048-7