Surveillance Scanning of Children with Medulloblastoma

Torres, Carlos F.; Rebsamen, Susan; Silber, Jeffrey H.; Sutton, Leslie N.; Bilaniuk, Larissa T.; Zimmerman, Robert A.; Goldwein, Joel W.; Phillips, Peter C.B.; Lange, Beverly J.

doi:10.1056/nejm199403313301303

Cited by 163 publications

(80 citation statements)

References 24 publications

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“…Although this has been disputed, it was believed that identifying and treating a disease recurrence as early as possible would have an effect on disease progression and survival. 34,35 If an institution has a particular follow-up schedule protocol in place, then the results from the current study suggest that, regardless of the follow-up schedule protocol chosen, its frequency should be consistent for the first 2 years for both children and adults, because the likelihood of mortality remains the same for the first 2 years. For reasons that are unclear, adolescents are significantly less likely to die in the first year after diagnosis compared with adults and children.…”

Section: Applications For Follow-upmentioning

confidence: 81%

Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs)

Smoll

2011

Cancer

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BACKGROUND: Medulloblastomas are 1 of the most common brain tumors in children but can affect individuals of all ages. For this report, the author investigated the impact of medulloblastomas/primitive neuroectodermal tumors (PNETs) on the US population with a focus on age differences. METHODS: Data from the Surveillance, Epidemiology, and End Results (SEER) database were used to describe cumulative relative survival (CRS) using crude, period, and longitudinal period approaches for patients diagnosed with all medulloblastoma subtypes and PNETs. CRS estimates were obtained using SEER expected mortality data and the Ederer II method for expected survival estimation. These data were applied to the construction of rational follow-up scheduling protocols. RESULTS: The 5-year period CRS for all patients who were followed between 2001 and 2006 was 69%. Adults had a worse overall prognosis, but this difference in excess hazard rates appeared only after 4 years of follow-up. Furthermore, the 5-year and 10-year CRS has improved a minimum of 11% in children, adolescents, and adults over the past 25 years. CONCLUSIONS: The survival difference between children, adolescents, and adults with medulloblastomas and PNETs depended on the length of follow-up, which was described in this report as an age-by-follow-up interaction and observed as a ''fork'' on Kaplan-Meier curves. Differences in survival between children and adults emerged only 4 years after diagnosis, and adults fared worse. There has been significant improvement in survival from medulloblastomas/PNETs since the late 1970s and early 1980s. Cancer 2012;118:1313-

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Section: Applications For Follow-upmentioning

confidence: 81%

Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs)

Smoll

2011

Cancer

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“…Recurrent medulloblastoma has a dismal prognosis (18)(19)(20)(21)(22)(23)(24). Therefore, the distinction between radiographic changes related to normal tissue damage by chemoradiotherapy and true disease progression affects the patient's subsequent treatment and prognosis.…”

Section: Resultsmentioning

confidence: 99%

Changes Mimicking New Leptomeningeal Disease After Intensity-Modulated Radiotherapy for Medulloblastoma

Muscal

Jones

Paulino

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Acute and late changes in magnetic resonance imaging of the pediatric brain have been described after radiotherapy (RT). We report the post-RT neuroimaging changes in the posterior fossa after intensity-modulated RT (IMRT) in children with medulloblastoma and contrast them with those of leptomeningeal disease.Methods and Materials-We performed a retrospective review of 53 consecutive children with medulloblastoma who were treated with craniospinal RT followed by IMRT to the posterior fossa and chemotherapy between 1997 and 2006.Results-After IMRT to the posterior fossa, 8 (15%) of 53 patients developed increased fluidattenuated inversion-recovery signal changes in the brainstem or cerebellum and patchy, multifocal, nodular contrast enhancement at a median of 6 months. The enhancement superficially resembled leptomeningeal disease. However, the enhancement resolved without intervention at a median of 6 months later. The accompanying fluid-attenuated inversion-recovery signal changes occasionally preceded the enhancement, were often parenchymal in location, and resolved or persisted to a lesser degree. All 8 patients with transient magnetic resonance imaging changes in the posterior fossa were alive at last follow-up. In contrast, leptomeningeal disease occurred in 8 (15%) of our 53 patients at a median of 19.5 months after IMRT completion. Of these 8 patients, 7 demonstrated initial nodular enhancement outside the conformal field, and 7 patients died.Conclusion-Magnetic resonance imaging changes can occur in the posterior fossa of children treated with IMRT for medulloblastoma. In our experience, these transient changes occur at a characteristic time and location after RT, allowing them to be distinguished from leptomeningeal disease.

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“…1 Currently, there is no generally acceptable therapy for tumor recurrences. The most active chemotherapeutic agents include cisplatin or carboplatin, 2-4 lowdose oral etoposide, 5 PCV (procarbazine, CCNU, vincristine), 6 MOPP (nitrogen mustard, vincristine, procarbazine, prednisone), 7 and intraventricular and intrathecal therapy with Ara-C, methotrexate and thiotepa.…”

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confidence: 99%

“…8 Despite reasonably high response rates of 40-75% with these agents, no long-term disease-free survival has been reported. [1][2][3][4][5][6][7][8][9] Given that these agents are amenable to substantial dose-escalation, evaluation of high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) has been suggested. 9 Promising results with HDCT/ASCT prompted us to use this form of therapy for young adults with recurrent medulloblastoma, who were otherwise healthy and had no possibility of cure with conventional dose therapy.…”

mentioning

confidence: 99%

Possible benefits of high-dose chemotherapy and autologous stem cell transplantation for adults with recurrent medulloblastoma

Zia

Chaudhry

Russell

et al. 2002

Bone Marrow Transplant

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Summary:In an attempt to improve the dismal prognosis of adults with recurrent medulloblastoma, six patients were treated with aggressive salvage therapy including highdose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). At relapse, all patients underwent surgical debulking followed by HDCT/ASCT and then radiotherapy when possible. The treatment plan included two cycles of HDCT/ASCT; first with cyclophosphamide, etoposide and carboplatin (CECb) and then 2 months later with cyclophosphamide and thiotepa (CT). Three of the six patients received the planned therapy. One patient experienced severe toxicity requiring life-sustaining therapy. This patient developed multi-organ dysfunction including multiple enhancing lesions in both cerebral hemispheres that slowly resolved over several months. Two other patients did not mobilize sufficient stem cells for two ASCT procedures. They received one ASCT conditioned with cyclophosphamide, thiotepa and carboplatin (CTCb). Three of six patients had a complete response (CR); the other three had a partial response (PR). Following the first ASCT, median duration of response was 13.5 months (range 9-29 months) and median survival was 21.5 months (range 12-42 months). There was no treatment-related mortality. We conclude that HDCT/ASCT with CECb-CT or CTCb is active against recurrent medulloblastoma in adults and may be associated with prolonged remissions. Multiple enhancing cerebral lesions on brain MRI early post-HDCT/ASCT may be a consequence of the treatment rather than metastatic disease.

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Surveillance Scanning of Children with Medulloblastoma

Abstract: Among children with medulloblastoma, surveillance scanning is of little clinical value. Scanning detected a minority of recurrences, and no patient who had a recurrence survived.

Cited by 163 publications

References 24 publications

Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs)

Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs)

Changes Mimicking New Leptomeningeal Disease After Intensity-Modulated Radiotherapy for Medulloblastoma

Possible benefits of high-dose chemotherapy and autologous stem cell transplantation for adults with recurrent medulloblastoma

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