Ototoxicity After Intensity-Modulated Radiation Therapy and Cisplatin-Based Chemotherapy in Children With Medulloblastoma

Paulino, Arnold dela Cruz; Lobo, M.; Teh, Bin S.; Okcu, M. Fatih; South, Michael S.; Butler, E. Brian; Su, Jack M.; Chintagumpala, Murali

doi:10.1016/j.ijrobp.2009.09.031

Cited by 91 publications

(78 citation statements)

References 24 publications

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“…The role of new techniques, for example IMRT (Intensity Modulated Radiation Therapy), tomotherapy, protontherapy, and carbon ion radiation in the reduction of doses to OARs during the irradiation of brain malignancies is under investigation [63][64][65], as well as the role of new imaging techniques [66]. Results also seem promising for medulloblastoma patients, although they should be prospectively evaluated and some reports are not completely satisfactory [63][64][65][67][68][69][70][71][72], indicating that particular attention should be given to the volumes of treatment and to the toxic effects of concomitant chemotherapy [73,74]. Despite the small number of analysed patients, our results seem to show that radiation therapy results in a good outcome without a significant negative late impact on neuropsychological abilities.…”

Section: Discussionmentioning

confidence: 99%

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

Boccadoro¹,

Chiesa²,

Chieffo

et al. 2011

J Neurooncol

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Medulloblastoma (MB) occurs infrequently in adult patients and standard treatment is still controversial. We report our long-term, single-institution experience of adult MB and a review of the literature. We analysed adult patients with histologically proved MB treated by postoperative radiotherapy. Primary endpoints were local control (LC), disease-free survival (DFS), and overall survival (OS). Acute toxicity was reported according to CTC-NCI score vers. 3.0 and specific neuropsychological assessment analysis was performed to define late brain toxicity. From 1990-2008, 13 patients were treated by craniospinal (CSI, 12/13) or cranial irradiation (1/13, because of bad clinical conditions). Median follow up was 101 months (64-218). Complete radiological response was observed in 12/13 patients and a partial response in 1/13. Ten-year LC, OS, and DFS were 91, 76, and 84%, respectively. Two patients died because of local and spinal progression after 13 and 62 months. Acute G3 haematological toxicity (RTOG score) was observed for one patient only. The neuropsychological analysis did not reveal late toxicity related to brain radiotherapy. This experience confirms the efficacy and safety of radiotherapy in adult MB patients, resulting in very interesting 10-year LC and OS.

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Section: Discussionmentioning

confidence: 99%

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

Boccadoro¹,

Chiesa²,

Chieffo

et al. 2011

J Neurooncol

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“…While the locoregional control rates were not statistically different, target dose coverage was better for IMRT [42]. Regarding late toxicity, the main complication that IMRT might have an advantage compared with more conventional techniques is ototoxicity in children receiving RT and cisplatin for medulloblastoma [35,44,45]. The initial paper from The Methodist Hospital of 15 patients with a median follow-up of 18 months demonstrated a reduction from 64 to 13 % grades 3 to 4 hearing loss with lowering of RT dose to the cochlea [44].…”

Section: Use Of Novel Rt Technologymentioning

confidence: 97%

“…The initial paper from The Methodist Hospital of 15 patients with a median follow-up of 18 months demonstrated a reduction from 64 to 13 % grades 3 to 4 hearing loss with lowering of RT dose to the cochlea [44]. A more recent analysis with 44 children and a median audiogram follow-up of 41 months showed 25 % grades 3 to 4 hearing loss [45]. Another report from Memorial Sloan-Kettering Cancer Center showed a 6 % grade 3 hearing loss with IMRT at a median audiogram follow-up of 19 months [35].…”

Section: Use Of Novel Rt Technologymentioning

confidence: 99%

Treatment strategies to reduce radiotherapy late effects in children

Paulino

2012

J Radiat Oncol

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Late effects of treatment are an important cause of morbidity and mortality in childhood cancer survivors. The use of radiotherapy has been implicated as a risk factor for the development of many late complications. Several strategies have been employed in pediatric oncology to minimize the late effects of radiotherapy. These have included (1) omitting or delaying radiotherapy until the child is older, (2) decreasing radiotherapy doses and volumes by incorporating chemotherapy in the treatment regimen, (3) alteration of radiotherapy fractionation, (4) use of novel techniques to spare or minimize radiation dose to surrounding normal tissues, and (5) elimination of radiotherapy in favorable subsets of patients. In infants with brain tumors, delaying radiotherapy and giving chemotherapy until the child is 3 years old was a popular approach three to four decades ago with limited success with respect to tumor control. With the advent of modern radiotherapy technology, younger patients are now able to be treated with conformal techniques and reasonable neurotoxicity. Using chemotherapy to reduce doses of radiation therapy has been employed in standard-risk medulloblastoma, intracranial germinoma, Hodgkin lymphoma, and Wilms' tumor. Likewise, the use of chemotherapy to reduce radiotherapy volumes has been employed in intracranial germinoma, Hodgkin lymphoma, and neuroblastoma and for the boost portion of treatments for rhabdomyosarcoma and Ewing sarcoma. There are a few phase III trials comparing conventional and hyperfractionated radiotherapy, but none of them have shown superiority of one over the other in terms of tumor control and late effects. Current protocols are testing the omission of radiotherapy in the most favorable subset of patients with Hodgkin lymphoma and Wilms' tumor. Intensity-modulated radiation therapy is currently used in many children in developed nations. Proton therapy is available in a few centers; clinical results of treatment are accumulating regarding the effectiveness and longterm toxicity of this radiation modality.

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“…Various strategies have been considered to minimize platinum ototoxicity. Radiation reduction dose to the cochlea has been investigated, including the use of 3D conformal RT, IMRT, and proton therapy [72]. Once treatment is completed, long-term audiometric monitoring should continue.…”

Section: Ototoxicitymentioning

confidence: 99%

Pediatric Neuro-Oncology in Low-/Middle-Income Countries

Zaghloul¹

2016

Neurooncology - Newer Developments

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Pediatric cancer is becoming increasingly important in low-/middle-income countries (LMICs), due to the improvement in controlling communicable diseases, decrease infant, and early childhood mortalities associated with infection and malnutrition.Worldwide, although much improvement was encountered in many pediatric tumors particularly acute leukemia that represents the commonest type of cancer in children, this was not so obvious in CNS tumors, the second most common tumor type. Slow advances have been achieved to improve treatment end results in pediatric neuro-oncology. This was largely related to disease under diagnosis, incorrect clinical assessment, improper staging, and lack of the availability of appropriate radiologic, neurosurgical, and radiotherapeutic services in LMICs. Moreover, the need for multidisciplinary team working together to embalmment unified approved management guidelines, highly specific care level within a widely accepted quality control measures are of utmost importance to raise the treatment outcome levels to that of high-income countries (HICs).Much effort is needed in LMICs to improve the management of pediatric CNS tumors, decrease the gap, and reach good results already attained by the dedicated centers in HICs. There are many international organizations and societies that can and are willing to help in this matter.In this chapter, an illustration of the obstacles faced by LMIC neuro-oncologists will be discussed. The different ways and procedures are recommended to improve the general situation to attain good results similar to that in HICs.

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Ototoxicity After Intensity-Modulated Radiation Therapy and Cisplatin-Based Chemotherapy in Children With Medulloblastoma

Cited by 91 publications

References 24 publications

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

Treatment strategies to reduce radiotherapy late effects in children

Pediatric Neuro-Oncology in Low-/Middle-Income Countries

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