Hyperfractionated Irradiation and Concurrent Cisplatin in Brain Stem Tumors: A Pediatric Oncology Group Pilot Study (9139)

Kadota, Richard; Mandell, Lynda R.; Fontanesi, James; Kovnar, Edward H.; Krischer, Jeffrey P.; Kun, Larry E.; Friedman, Henry S.

doi:10.1159/000120794

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…There are, however, few reports of clinical and experimental studies of combined modalities. One case report discusses progressive sensorineural hearing loss after completion of therapy by use of both cis ‐platinum and radiation for cerebellar neoplasm in a child 9 . Our retrospective study here describes and compares histopathologic changes seen in human temporal bones of patients who had been treated with cis ‐platinum, radiation, or concomitant cis ‐platinum and radiation.…”

Section: Figmentioning

confidence: 99%

Histopathology of Human Temporal Bone AfterCis‐Platinum, Radiation, or Both

Hoistad

Ondrey

Mutlu

et al. 1998

Otolaryngol.--head neck surg.

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Preserving organs by use of multiple modalities has become protocol in treating squamous cell carcinomas of the head and neck, but cis-platinum and radiation can impair hearing. To determine the effect of cis-platinum, radiation, or a combination of these treatments on the temporal bone, we studied histopathologic slides of 15 human temporal bones: four after cis-platinum, five after radiation, two after combined treatment, and four from normal controls. Hair cells and cells in spiral ganglia were counted in reconstructed organs of Corti. Lumen-to-diameter indexes in arterioles near facial nerves were quantified for four normal controls and seven irradiated patients. Available audiograms were compared. Decreased spiral ganglion cells, loss of inner and outer hair cells, and atrophy of stria vascularis were demonstrated in groups receiving cis-platinum, radiation, and combinations, compared with age-matched controls. Arterioles around facial nerves demonstrated fibrinous clots within the intima, endothelial proliferation, and hypertrophy and fibrosis of vascular walls in smooth muscle. Fibrosis in connective tissue was clearly progressive after radiation. Cis-platinum and radiation can contribute to otologic sequelae, including sensorineural hearing losses, vascular changes, serous effusion, or fibrosis. Prophylactic treatments and techniques to deliver them should be considered for protection of temporal bones and preservation of hearing after oncologic modalities.

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Section: Figmentioning

confidence: 99%

Histopathology of Human Temporal Bone AfterCis‐Platinum, Radiation, or Both

Hoistad

Ondrey

Mutlu

et al. 1998

Otolaryngol.--head neck surg.

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“…2 Increasing total dose by hyperfractionation produced median survival of 9-12 months in several uni-and multi centric trials. [3][4][5][6][7][8][9] Chemotherapy also failed to improve prognosis, whether given orally, 10 -12 intravenously at standard dose, [13][14][15][16][17][18][19][20][21][22] intra-arterially, 23 or at high dose with stem cell rescue. [24][25][26][27][28] Similarly, clear improvement did not occur after chemotherapy given at time of progression.…”

mentioning

confidence: 99%

Preradiation chemotherapy may improve survival in pediatric diffuse intrinsic brainstem gliomas: Final results of BSG 98 prospective trial

et al. 2008

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Radiation therapy remains the only treatment that provides clinical benefit to children with diffuse brainstem tumors. Their median survival, however, rarely exceeds 9 months. The authors report a prospective trial of frontline chemotherapy aimed at delaying radiation until time of clinical progression. The aim was to investigate the possibility that radiotherapy would maintain its activity in children whose disease progressed after chemotherapy. Twenty-three patients took part in this protocol, the BSG 98 protocol, which consisted of frontline chemotherapy alternating hematotoxic and nonhematotoxic schedules. Each cycle included three courses delivered monthly; the first course was 1,3-bis(2-chloroethyl)-1-nitrosoureacisplatin, and the second and third were high-dose methotrexate. Three patients underwent one cycle; 5 patients each, two and three cycles; and 10 patients, four cycles. Twenty of the 23 patients eventually received local radiation therapy. A historical cohort of 14 patients who received at least local radiation therapy served as controls. Four patients experienced severe iatrogenic infections, and 11 patients required platelet transfusions. Median survival increased significantly in patients participating in the protocol compared to that in the historical controls (17 months, 95% confidence interval [CI], 10-23 months, vs. 9 months, 95% CI, 8-10 months; p = 0.022), though hospitalization was prolonged (57 vs. 25 days, p = 0.001). Although frontline chemotherapy alternating hematotoxic and nonhematotoxic schedules significantly increases overall median survival, its cost from infection and hospitalization deserves honest discussion with the children and their parents.

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“… 3 When similar treatments are given in combination for brainstem gliomas, as many as half of the patients experience ototoxicity. 4 Other ear‐related toxicities that are associated with radiation to the nasopharynx and parotid include chronic radiation otomastoiditis, osteoradionecrosis of the temporal bone, and eustachian tube dysfunction. 5,6 These toxicities also may contribute to hearing loss and have been considered unintended consequences of treatment.…”

Section: Introductionmentioning

confidence: 99%

Radiation Dose to Otologic Structures During Head and Neck Cancer Radiation Therapy

2000

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Background: Otologic structures are often con· tained within head and neck cancer radiation treatment ports. The dosimetry to otologic structures has not been routinely analyzed and radiation treatment planning does not currently attempt to specifically avoid the inner ear structures when dosimetry is calculated. Recent studies demonstrate that up to 30o/ o of patients experie~e sensorineural hearing loss on multimodality tlierapy with cisplatin and radiation. Methods: In the current case series, radiation dosimetry to otologic structures was calculated from computed tomogram treatment plans on patients. Fifteen nasopharyngeal, oral cavity, oropharyngeal, and hypopharyngeal cancer patients were analyzed. Results: Between 8% and 102% of the total dose is delivered to the petrous bone/cochlea, with 4of15 patients getting more than 50% of the dose to at least one cochlea. The mastoid air cells received between 3% and 75% of the total dose, with higher doses being delivered to pa· tients with bulky high neck metastases or nasopharyngeal tumors. The eustachian tubes received between 2% and 102% of the total dose, with 10 of 15 patients receiving more than 50o/o of the dose to this anatomic site. Conclusion: We conclude that the cochlea and eustachian tubes receive significant radiation during treatment, particularly in nasopharyngeal cancer patients. Careful design of radiation treatment ports may allow for the reduction of radiation to hearing structures.

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Hyperfractionated Irradiation and Concurrent Cisplatin in Brain Stem Tumors: A Pediatric Oncology Group Pilot Study (9139)

Cited by 7 publications

References 22 publications

Histopathology of Human Temporal Bone AfterCis‐Platinum, Radiation, or Both

Histopathology of Human Temporal Bone AfterCis‐Platinum, Radiation, or Both

Preradiation chemotherapy may improve survival in pediatric diffuse intrinsic brainstem gliomas: Final results of BSG 98 prospective trial

Radiation Dose to Otologic Structures During Head and Neck Cancer Radiation Therapy

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