Proton Therapy for Spinal Ependymomas: Planning, Acute Toxicities, and Preliminary Outcomes

Amsbaugh, Mark J.; Grosshans, David R.; McAleer, Mary Frances; Zhu, Ronald X.; Wages, Cody A.; Crawford, C.; Palmer, Matthew; Gracia, Beth De; Woo, Shiao Y.; Mahajan, Anita

doi:10.1016/j.ijrobp.2011.10.034

Cited by 46 publications

(25 citation statements)

References 21 publications

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“…Few children treated with pbt developed growth hormone deficiency (n = 2), central hypothyroidism (n = 1), or hearing loss (n = 2). Amsbaugh et al 21 reported local control and overall survival rates of 100% at a mean follow-up of 26 months in 8 children with spinal ependymoma treated with pbt. No patients experienced grade 3 or greater adverse events.…”

Section: Pediatricsmentioning

confidence: 99%

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

et al. 2014

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able and willing to travel abroad to a proton facility. Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents who have the greatest risk for long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head-and-neck, breast, lung, gastrointestinal tract, and pelvic cancers, including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases.

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Section: Pediatricsmentioning

confidence: 99%

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

et al. 2014

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“…After perusing the full content of these articles, 20 publications were selected for final inclusion in this systematic review (Table 1). 1,2,4,5,7,8,10,[12][13][14]16,17,[19][20][21][22][23]26,31,32 …”

Section: Search Strategymentioning

confidence: 99%

“…Second, some authors who have performed GTR + RT have not described or evaluated radiological features of the tumor in their reports, which may underestimate the exact numbers of aggressive lesions in this group. 1,5,19 Inclusion of this information becomes essential, especially when 3 of the 4 recurrences in the GTR + RT group were distant. The effect of selection bias gains more importance because the only patient who died of disease had undergone GTR + RT.…”

Section: 14mentioning

confidence: 99%

Cumulative survival analysis of patients with spinal myxopapillary ependymomas in the first 2 decades of life

Kukreja¹,

Ambekar²,

Sin³

et al. 2014

PED

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Object Reports of myxopapillary ependymomas (MPEs) of the spinal cord in pediatric patients are scarce. In the literature, various authors have shared their experiences with small groups of patients, which makes it difficult to create a consensus regarding the treatment approach for spinal MPEs in young patients. The aim of this study was to perform a survival analysis of patients in the first 2 decades of life whose cases were selected from the published studies, and to examine the influence of various factors on outcomes. Methods A comprehensive search of studies published in English was performed on PubMed. Patients whose age was ≤ 20 years were included for integrative analysis. Information about age, treatment characteristics, critical events (progression, recurrence, and death), time to critical events, and follow-up duration was recorded. The degree of association of the various factors with the survival outcome was calculated by using Kaplan-Meier estimator and Cox proportional hazard model techniques. Results A total of 95 patients were included in the analysis. The overall rate of recurrence (RR) was 34.7% (n = 33), with a median time to recurrence of 36 months (range 2–100 months). Progression-free survival (PFS) and overall survival rates at 5 years were 73.7% and 98.9%, respectively. Addition of radiotherapy (RT) following resection significantly improved PFS (log-rank test, p = 0.008). In patients who underwent subtotal resection (STR), administering RT (STR + RT) improved outcome with the lowest failure rates (10.3%), superior to patients who underwent gross-total resection (GTR) alone (RR 43.1%; log-rank test, p < 0.001). Addition of RT to patients who underwent GTR was not beneficial (log-rank test, p = 0.628). In patients who had disseminated tumor at presentation, adjuvant RT controlled the disease effectively. High-dose RT (≥ 50 Gy) did not change PFS (log-rank test, p = 0.710). Conclusions Routine inclusion of RT in the treatment protocol for spinal MPEs in young patients should be considered. Complete resection is always the goal of tumor resection. However, when complete resection does not seem to be possible in complex lesions, RT should be used as an adjunct to avoid aggressive resection and to minimize inadvertent injury to the surrounding neural tissues. High-dose RT (≥ 50 Gy) did not provide additional survival benefits, although this association needs to be evaluated by prospective studies.

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“…Amsbaugh et al [38] have recently published the preliminary outcomes of eight pediatric spine ependymoma patients treated with PT at MD Anderson Cancer Center; they have obtained LC, EFS and OS rates of 100% after a mean follow up of 26 months and mild acute toxicities.…”

Section: Medulloblastomamentioning

confidence: 99%

Proton Radiotherapy for Childhood Tumors: an Overview of Early Clinical Results

MacDonald¹

2013

J Nucl Med Radiat Ther

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Radiation therapy (RT) is an important part of a multidisciplinary treatment for many pediatric tumors and has been integral to the improvement in disease control seen over the past few decades. However, long-term survivors experience late morbidity related to RT. Proton radiation therapy is an emerging type of radiotherapy that can mitigate the incidence of acute and late side effects by minimizing the dose of radiation to normal tissues with a significant reduction of integral dose compared with photons. Furthermore, true clinical advantages are now being measured and published in the medical literature, showing both excellent disease control rates and reduction of late effects. The purpose of this review is to summarize the early clinical outcomes after proton radiotherapy in childhood available in the literature.

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Proton Therapy for Spinal Ependymomas: Planning, Acute Toxicities, and Preliminary Outcomes

Cited by 46 publications

References 21 publications

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Recommendations for the Referral of Patients for Proton-Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Cumulative survival analysis of patients with spinal myxopapillary ependymomas in the first 2 decades of life

Proton Radiotherapy for Childhood Tumors: an Overview of Early Clinical Results

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