Reducing Toxicity from Craniospinal Irradiation

Yuh, Grace E.; Loredo, Lilia N.; Yonemoto, Les T.; Bush, David A.; Shahnazi, Kambiz; Preston, William; Slater, James M.; Slater, Jerry D.

doi:10.1097/00130404-200411000-00009

Cited by 118 publications

(30 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early reports of proton use shows that clinical responses can be achieved at a similar rate to photons. There are many small studies reporting reduced dosimetry to non-target tissues and even reduced incidence of secondary malignancy [28,29]. There is a robust experience using photon based radiation approaches in MB, and the long term outcome data for proton based therapy is just starting to mature.…”

Section: Interventional Proceduresmentioning

confidence: 99%

Management of Pediatric and Adult Patients with Medulloblastoma

Martin

Raabe

Eberhart

et al. 2014

Curr. Treat. Options in Oncol.

View full text Add to dashboard Cite

Section: Interventional Proceduresmentioning

confidence: 99%

Management of Pediatric and Adult Patients with Medulloblastoma

Martin

Raabe

Eberhart

et al. 2014

Curr. Treat. Options in Oncol.

View full text Add to dashboard Cite

“…In all subgroups of patients, surgery is first line treatment, which aims for maximal tumor resection. Postsurgical treatment is then varied with high-risk groups receiving higher-dose multimodal chemotherapy protocols in addition to craniospinal radiation (2, 37–40). There are substantial concerns, however, over the long-term neurocognitive sequelae of whole brain radiation on the developing brain meaning that in patients younger than the age of 3 years (or sometimes as old as 7 years) craniospinal radiation is often delayed or eliminated (3, 38–44).…”

Section: Therapeutic Targeting Of Medulloblastomasmentioning

confidence: 99%

Pediatric Medulloblastoma â€“ Update on Molecular Classification Driving Targeted Therapies

et al. 2014

View full text Add to dashboard Cite

As advances in the molecular and genetic profiling of pediatric medulloblastoma evolve, associations with prognosis and treatment are found (prognostic and predictive biomarkers) and research is directed at molecular therapies. Medulloblastoma typically affects young patients, where the implications of any treatment on the developing brain must be carefully considered. The aim of this article is to provide a clear comprehensible update on the role molecular profiling and subgroups in pediatric medulloblastoma as it is likely to contribute significantly toward prognostication. Knowledge of this classification is of particular interest because there are new molecular therapies targeting the Shh subgroup of medulloblastomas.

show abstract

“…Consequently, most radiation oncologists prefer to include the entire vertebral body and growth plate in the treatment volume for growing children and uniformly inhibit growth rather than risk inducing lordosis from radiation dose asymmetry anterior to posterior. Yuh, et al published early results on the treatment of three young patients treated with CSI with a single posteroanterior beam direction using three matched fields along the superior-inferior direction, with the beam stopping just beyond the thecal sac (8). The authors reported favorable early outcomes as minimal effects on blood counts were reported for these children and they experience less nausea, decreased appetite and odynophagia than would be expected for CSI.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Intensity Modulated Proton Therapy Relative to Passive Scattering Proton Therapy for Increased Vertebral Column Sparing in Craniospinal Irradiation in Growing Pediatric Patients

Giantsoudi

Seco

Eaton

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose At present, proton craniospinal irradiation (CSI) for growing children is delivered to the whole vertebral body (WVB) to avoid asymmetric growth. We aim to demonstrate the feasibility and potential clinical benefit of delivering vertebral body sparing (VBS) versus WVB CSI with passively scattered (PS) and intensity modulated proton therapy (IMPT) in growing children treated for medulloblastoma. Methods Five plans were generated for medulloblastoma patients, previously treated with CSI PS proton radiation therapy (PRT): (a) single posterior-anterior (PA) PS field covering the WVB (PS-PA-WVB), (b) single PA PS field including only the thecal sac in the target volume (PS-PA-VBS), (c) single PA IMPT field covering the WVB (IMPT-PA-WVB), (d) single PA IMPT field, target volume including thecal sac only (IMPT-PA-VBS) and (e) two posterior-oblique (−35°, 35°) IMPT fields, target volume including thecal sac only (IMPT2F-VBS). For all cases, 23.4Gy(RBE) was prescribed to 95% of the spinal canal. Dose, LET and variable-RBE-weighted dose distributions were calculated for all plans using the TOPAS Monte Carlo system. Results IMPT VBS techniques spared efficiently the anterior vertebral bodies (AVB), even when accounting for potential higher variable RBE predicted by linear energy transfer (LET) distributions. Assuming RBE=1.1, V10Gy(RBE) decreased from 100% for the WVB techniques to 59.5–76.8% for the cervical, 29.9–34.6% for the thoracic and 20.6–25.1% for the lumbar, and V20Gy(RBE) decreased from 99.0% to 17.8–20.0% for the cervical, 7.2–7.6% for the thoracic and 4.0–4.6% for the lumbar AVB when IMPT VBS techniques were applied. Corresponding values for the PS VBS technique were higher. Conclusions Advanced proton techniques may sufficiently reduce the dose to the vertebral body and allow for vertebral column growth for children with CNS tumors requiring CSI. This holds even when considering variable RBE values. A clinical trial is planned for VBS to the thoracic and lumbosacral spine in growing children.

show abstract

Reducing Toxicity from Craniospinal Irradiation

Cited by 118 publications

References 25 publications

Management of Pediatric and Adult Patients with Medulloblastoma

Management of Pediatric and Adult Patients with Medulloblastoma

Pediatric Medulloblastoma â€“ Update on Molecular Classification Driving Targeted Therapies

Evaluating Intensity Modulated Proton Therapy Relative to Passive Scattering Proton Therapy for Increased Vertebral Column Sparing in Craniospinal Irradiation in Growing Pediatric Patients

Contact Info

Product

Resources

About