Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review

Rao, Avani D.; Rashid, Arif; Chen, Qinyu; Villar, R.C.; Kobyzeva, Daria; Nilsson, Kristina; Dieckmann, Karin; Nechesnyuk, A. V.; Ermoian, Ralph; Alcorn, Sara R.; MacDonald, Shannon M.; Ladra, Matthew M.; Ford, Eric; Winey, B.; Figueiredo, Maria Luisa S.; Chen, Michael; Terezakis, Stephanie A.

doi:10.1016/j.ijrobp.2017.07.026

Cited by 41 publications

(36 citation statements)

References 18 publications

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“…The number of publications concerning reirradiation after CSI is small, and the number of patients described in all the reports does not exceed 300 cases [12–25]. …”

Section: Discussionmentioning

confidence: 99%

“…The outcome is poor, irrespective of the implemented treatment methods (surgery, chemotherapy, combined in some cases with bone marrow transplantation, brachytherapy, radiosurgery, or hypofractionated stereotactic radiotherapy). So far, only two authors reported 5-year OS of 55–65% [7–25]. …”

Section: Introductionmentioning

confidence: 99%

“…Publications on the reirradiation of patients after radiotherapy of cerebrospinal axis are scarce, and radiotherapy is often not considered a salvage treatment because of its potential toxicity (including radiation necrosis of the brain), young age of patients, and uncertain effectiveness [5, 10–25]. …”

Section: Introductionmentioning

confidence: 99%

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Radiosurgery or hypofractionated stereotactic radiotherapy after craniospinal irradiation in children and adults with medulloblastoma and ependymoma

et al. 2018

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PurposeTo assess the results and tolerance of radiosurgery/hypofractionated stereotactic radiotherapy performed after craniospinal irradiation for recurrent tumor.MethodsFourteen patients aged 3–46 years, diagnosed with medulloblastoma (10), anaplastic ependymoma (3), and primitive neuroectodermal tumor (1). All patients had craniospinal irradiation (CSI) with the total dose of 30.6–36 Gy and boost to 53.9–60 Gy either during primary or during second-line treatment. Twelve patients were irradiated with a single dose of 6–15 Gy (median 14.5 Gy). One received three fractions of 5 Gy and one six fractions of 5 Gy. In statistical analysis, the Kaplan-Meier method and log-rank test were used. The overall survival was calculated from the date of the end of stereotactic radiosurgery to the date of death or last contact.ResultsRecurrences were diagnosed after the median time of 16 months after the end of primary treatment. Eleven patients died during the follow-up. The follow-up for the 3 patients still alive was 6.7, 40.5, and 41.4 months, respectively. One- and 2-year overall survival (OS) was 70% and 39%. Patients who had ECOG performance status of 0 at the time of diagnosis of the disease trended to have better 2-year OS compared to those evaluated as ECOG 1 (p = 0.057). Treatment results were evaluable in 12 patients. Local control (stabilization or regression of the lesion) was achieved in 9 (75%). Overall disease progression was 67%. No patient developed radiation-induced necrosis. The treatment was well tolerated and no serious adverse effects were observed. Eleven patients were given steroids as a prevention of brain edema and four of them needed continuation of this treatment afterwards. In 7 patients, symptoms of brain edema were observed during the first weeks after reirradiation.ConclusionsStereotactic radiosurgery or hypofractionated stereotactic radiotherapy is an effective treatment method of the local recurrence after CSI and can be performed safely in heavily pre-treated patients.

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“…The number of publications concerning reirradiation after CSI is small, and the number of patients described in all the reports does not exceed 300 cases [12–25]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiosurgery or hypofractionated stereotactic radiotherapy after craniospinal irradiation in children and adults with medulloblastoma and ependymoma

et al. 2018

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“…External-beam radiotherapy can be offered either in a definitive setting or after maximal safe resection, despite most of the literature reports data concerning exclusive intent. To date, almost 300 cases of re-irradiation after craniospinal radiotherapy are reported in the literature (Table I), but it is hard to compare these data due to the heterogeneity of the in vivo 34: 1283-1288 (2020) cohorts; furthermore, different RT schedules are used with or without chemotherapy, and only a few reports are available on the use of stereotactic radiotherapy (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Salvage Re-irradiation Options in Adult Medulloblastoma: A Case Report and Review of the Literature

Cuccia

Mortellaro²,

Ognibene³

et al. 2020

In Vivo

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Background/Aim: Medulloblastoma is a rare tumor of adult age, while it occurs more frequently in children. Given the rarity, there is a lack of evidence for the treatment of recurrent disease. Few data are available about salvage reirradiation collecting very heterogeneous series. Case Report: A 51-year-old male presented with headache, nausea, double vision, and gait disorders. A contrast-enhanced brain-MRI showed the presence of multifocal medulloblastoma. After surgery, adjuvant craniospinal radiotherapy was performed, chemotherapy was stopped due to toxicity. After 27 months, a new MRI and a Methionine-PET revealed a late pontocerebellar relapse; multidisciplinary board decided for a SBRT treatment. The second course of RT was well tolerated and 14 months later, the patient is alive in good general conditions, with no evidence of disease. Conclusion: Our experience supports the use of salvage stereotactic radiotherapy as a safe and effective treatment option. Medulloblastoma is one of the most common central nervous system tumors of childhood (1), while it has an extremely lower incidence in the adult age, particularly in >40 years patients (2). Furthermore, in older patients it may occur with unusual presentations, like multifocal disease, of which only six cases are described in the literature (3-8). Due to its rarity in the older 1283 This article is freely accessible online.

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“…11,17,19 During their evolution, there are relapses, that could occur a few months to years after the first irradiation. 9,[13][14][15] Rao et al 8 reported reirradiation in 67 children with recurrent CNS malignancies and found that the median overall survival after the completion of repeated radiation therapy (RT) was 12.8-months for the entire cohort and concluded that CNS reirradiation could be a reasonable treatment option. In our study, a similar range of median overall survival was obtained (12.2-months).…”

Section: Discussionmentioning

confidence: 99%

Reirradiation of Recurrent Tumors in Central Nervous System in Children and Adolescents

Alert¹,

Chon²,

Ropero³

2019

Neuro Open J

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I n Cuba, tumors of the Central Nervous System (CNS) for children and adolescents account between 18 and 20% of all tumors in this group of age. 1-3 The main methods of treatment are surgery, radiotherapy, and chemotherapy. 4 Radiation therapy is a major treatment avenue in medulloblastomas, primitive neuroectodermal tumor (PNET) in some cases of germinomas consist of craneospinal irradiation (CS), and a supplementary boost to the post-operative tumor bed, followed by chemotherapy. In

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Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review

Cited by 41 publications

References 18 publications

Radiosurgery or hypofractionated stereotactic radiotherapy after craniospinal irradiation in children and adults with medulloblastoma and ependymoma

Radiosurgery or hypofractionated stereotactic radiotherapy after craniospinal irradiation in children and adults with medulloblastoma and ependymoma

Salvage Re-irradiation Options in Adult Medulloblastoma: A Case Report and Review of the Literature

Reirradiation of Recurrent Tumors in Central Nervous System in Children and Adolescents

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