Impact of radiotherapy parameters on outcome for patients with supratentorial primitive neuro-ectodermal tumours entered into the SIOP/UKCCSG PNET 3 study

Taylor, Roger; Donachie, Paul H. J.; Weston, Claire; Robinson, K. L.; Lucraft, Helen; Saran, Frank; Ellison, David W.; Ironside, James W.; Walker, David; Pizer, Barry

doi:10.1016/j.radonc.2009.02.017

Cited by 29 publications

(23 citation statements)

References 21 publications

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“…We suspect that a conventional field-based CSI technique for medulloblastoma will adequately cover these structures and their meningeal surfaces. 22 However, there is no consensus about how to approach this problem when planning volume-based RT, delivered with either photons or protons. A similar question is posed for ependymoma treatment and we suggest that the internal acoustic meatus (IAM), jugular foramen (JF) and hypoglossal canal (HC) may provide a breach in the natural barrier to local spread provided by the internal table of the skull.…”

Section: Clinical Settingmentioning

confidence: 99%

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Noble¹,

Scoffings²,

Ajithkumar³

et al. 2016

BJR

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Objective: There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. Methods: 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42,45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. Results: IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was 20.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Conclusion: Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

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Section: Clinical Settingmentioning

confidence: 99%

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Noble¹,

Scoffings²,

Ajithkumar³

et al. 2016

BJR

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“…After reviewing each abstract, 12 candidates for meeting our eligibility criteria were identified. After reading those 12 full-text articles, one paper (15) was excluded because updated results of the same trial were reported in another publication (16). A secondary analysis of data from five clinical trials was excluded because it did not report the impact of RT compliance on clinical outcomes (17).…”

Section: Selection Of Trialsmentioning

confidence: 99%

“…These included two lung cancer trials (20,21), three trials for medulloblastoma or supratentorial primitive neuroectodermal tumor (16,22,23), and one trial each for Ewing sarcoma (24), pancreatic cancer (9), and head and neck cancer (10). In all but one trial (10), RT QA reviews were performed in a post hoc fashion.…”

Section: Selection Of Trialsmentioning

confidence: 99%

“…Six studies (9,10,16,20,21,23) reported the influence of RT QA deviations on OS. Six studies (9,10,16,(22)(23)(24) reported the effects of RT QA deviations on secondary endpoints, including local or locoregional control (10,24), event-free survival (16,23), and relapse (9,22). Various definitions of RT deviations were employed by the included studies and are summarized in Table 1.…”

Section: Selection Of Trialsmentioning

confidence: 99%

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Radiotherapy protocol deviations and clinical outcomes: A meta-analysis of cooperative group clinical trials.

Ohri

Dicker

Doyle

et al. 2012

JCO

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181 Background: Several reports have linked noncompliance with radiotherapy (RT) protocol guidelines with inferior clinical outcomes. Here we perform a meta-analysis of prospective cooperative group trials to determine the impact of RT quality assurance (QA) deviations on disease control and overall survival (OS). Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials for multi-institutional trials that reported clinical outcomes in relation to RT quality assurance (QA) results. Hazard ratios (HRs) describing the impact of RT protocol noncompliance on outcomes were extracted directly from the original studies or calculated from survival curves. Analyses were performed to assess the impact of RT QA deviations on OS and secondary outcomes (local/locoregional control, event-free survival, relapse), which were grouped together. Pooled estimates were obtained using the inverse variance method. A random effects model was used in cases of significant effect heterogeneity (p<0.10 using Q test). Results: Eight studies met all inclusion criteria and were incorporated into this analysis. Four were pediatric trials (POG 8346, SFOP.TC 94, POG 9031, SIOP/UKCC PNET-3), and four studied adult patients (RTOG 73-01, SWOG 7628, TROG 02.02, RTOG 97-04). Six of these trials reported the impact of RT QA deviations on overall survival, and six described the effects of RT QA deviations on secondary endpoints. The frequency of RT QA deviations ranged from 8% to 71% (median: 40%). Using a random effects model, RT deviations were associated with a significant decrease in OS (HR = 1.74, 95% CI: 1.28 to 2.35, p<0.001). A similar effect was seen for secondary endpoints (HR = 1.79, 95% CI: 1.15 to 2.78, p=0.009). No evidence of publication bias was detected using the Egger test (p=0.361 for OS, p=0.468 for secondary endpoints). Conclusions: In clinical trials, RT protocol deviations are associated with increased risk of treatment failure and overall mortality. The magnitude of these effects demonstrates that RT QA results should be considered in the interpretation of clinical trial results. More importantly, the delivery of high-quality RT is critical for the successful treatment of cancer patients.

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“…In a retrospective analysis of 36 patients of SPNET treated over 25 years, Dirks et al demonstrated a trend towards better prognosis in children receiving systemic chemotherapy[16]. In the SIOP/ UKCCSG PNET 3 trial by Pizer et al, 68 patients of SPNET (pineal 23 % and non-pineal 77 %) received post-operative radiation to a dose of 55 Gy/33 fractions at 1.67 Gy/fraction/ day (CSI 35 Gy → boost 20 Gy)[23,36]. Pre-irradiation chemotherapy (4 cycles-alternating vincristine, etoposide, carboplatin and vincristine, etoposide, cyclophosphamide) was administered in 44 patients.…”

mentioning

confidence: 99%

Treatment outcome and patterns of failure in patients of pinealoblastoma: review of literature and clinical experience from a regional cancer centre in north India

et al. 2015

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Maximal safe resection followed by craniospinal irradiation and systemic chemotherapy with 6 cycles of carboplatin-etoposide regimen is a reasonable treatment strategy in patients of pinealoblastoma more than 8 years of age in a developing nation. However, the same strategy is less effective in younger children and innovative study designs of intensification of post-operative treatment must be explored in this age group.

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Impact of radiotherapy parameters on outcome for patients with supratentorial primitive neuro-ectodermal tumours entered into the SIOP/UKCCSG PNET 3 study

Cited by 29 publications

References 21 publications

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Radiotherapy protocol deviations and clinical outcomes: A meta-analysis of cooperative group clinical trials.

Treatment outcome and patterns of failure in patients of pinealoblastoma: review of literature and clinical experience from a regional cancer centre in north India

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