Use of proton therapy for re-irradiation in pediatric intracranial ependymoma

Eaton, Bree R.; Chowdhry, Varun Kumar; Weaver, Kenneth; Liu, Li; Ebb, David H.; MacDonald, Shannon M.; Tarbell, Nancy J.; Yock, Torunn I.

doi:10.1016/j.radonc.2015.07.023

Cited by 61 publications

(29 citation statements)

References 18 publications

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“…Proton beam therapy for reRT has been investigated at other disease sites including head and neck, 38,39 central nervous system, 40,41 lung, 42,43 gynecological, 44 and gastrointestinal malignancies. [45][46][47] A recent systematic review found that reRT with PBT is safe and effective.…”

Section: Discussionmentioning

confidence: 99%

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

et al. 2019

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To investigate adverse events (AEs, CTCAE v4.0) and clinical outcomes for proton beam therapy (PBT) reirradiation (reRT) for breast cancer. From 2011 to 2016, 50 patients received PBT reRT for breast cancer in the prospective Proton Collaborative Group (PCG) registry. Acute AEs occurred within 180 days from start of reRT. Late AEs began or persisted beyond 180 days. Fisher's exact and Mann‐Whitney rank‐sum tests were utilized. Kaplan‐Meier methods were used to estimate overall survival (OS) and local recurrence‐free survival (LFRS). Median follow‐up was 12.7 months (0‐41.8). Median prior RT dose was 60 Gy (10‐96.7). Median reRT dose was 55.1 Gy (45.1‐76.3). Median cumulative dose was 110.6 Gy (70.6‐156.8). Median interval between RT courses was 103.8 months (5.5‐430.8). ReRT included regional nodes in 84% (66% internal mammary node [IMN]). Surgery included the following: 44% mastectomy, 22% wide local excision, 6% lumpectomy, 2% reduction mammoplasty, and 26% no surgery. Grade 3 AEs were experienced by 16% of patients (10% acute, 8% late) and were associated with body mass index (BMI) > 30 kg/m2 (P = 0.04), bilateral recurrence (P = 0.02), and bilateral reRT (P = 0.004). All grade 3 AEs occurred in patients receiving IMN reRT (P = 0.08). At 1 year, LRFS was 93%, and OS was 97%. Patients with gross disease at time of PBT trended toward worse 1‐year LRFS (100% without vs. 84% with, P = 0.06). PBT reRT is well tolerated with favorable local control. BMI > 30, bilateral disease, and IMN reRT were associated with grade 3 AEs. Toxicity was acceptable despite median cumulative dose > 110 Gy.

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Section: Discussionmentioning

confidence: 99%

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

et al. 2019

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“…Given that the irradiation dose tolerance of supratentorial brain is higher than that of the brainstem, it is a logical supposition that reirradiation of supratentorial HGG should be similarly safe and effective as reirradiation of brainstem glioma . Reirradiation has also been evaluated in children with intracranial ependymoma and is safe and well‐tolerated, with a low incidence of necrosis …”

Section: Discussionmentioning

confidence: 99%

“…10 Reirradiation has also been evaluated in children with intracranial ependymoma and is safe and well-tolerated, with a low incidence of necrosis. [17][18][19][20] Repeat irradiation also has an emerging role in adults with recurrent glioblastoma. 9 Strengths of this study include the assembly of the largest known cohort of children with recurrent HGG treated with a repeat course of RT, with a comparison to a group of children who were not reirradiated.…”

Section: Prior Studiesmentioning

confidence: 99%

Repeat irradiation for children with supratentorial high‐grade glioma

Tsang

Oliveira

Bouffet

et al. 2019

Pediatric Blood & Cancer

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Background There are very few studies about the role of repeat irradiation (RT2) for children with recurrent supratentorial high‐grade glioma (HGG). It was the aim of this study to assess the effectiveness and safety of RT2 in this population. Procedure This was a retrospective cohort study of 40 children age 18 years and under with recurrent supratentorial HGG who had received at least one course of RT. In‐field reirradiation volumes included focal or whole brain RT, with doses ranging from 30 to 54 Gy. The primary endpoint was overall survival (OS) from the first day of RT2. Results Fourteen patients underwent RT2. The median survival of these patients was 6.5 months. Patients with ≥12 months elapsed time between RT1 and RT2 experienced longer OS than patients who had < 12 months (P = 0.009). There was no difference in OS between patients with or without germline mutations (e.g., Lynch, Li–Fraumeni, or constitutional mismatch‐repair deficiency, P = 0.20). Ten patients received RT2 that overlapped with RT1 volumes for locally recurrent disease. Of this group, 80% experienced clinical benefit from in‐field RT2, defined as clinical/radiologic response or stable disease. Ninety‐three percent completed the prescribed course of RT2, with one patient developing grade 3 radiation necrosis four months after RT2. When compared with 26 patients who were not offered reirradiation, those selected for RT2 had improved median survival from the time of first disease progression (9.4 vs 3.8 months, P = 0.005). Conclusions Reirradiation for children with recurrent supratentorial HGG is a safe, effective treatment that provides short‐term disease control.

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“…report on a series of five patients treated with wide‐field reirradiation using pulsed reduced dose rate and none of the patients developed necrosis on serial magnetic resonance imaging scans. Proton radiotherapy has been used for reirradiation for relapsed ependymoma with good efficacy (3‐year overall survival and progression‐free survival are reported as 78.6% and 28.1%, respectively) and reasonable toxicity with 21.4% of locally retreated patients having experienced grade 2 radiation‐associated treatment change …”

Section: Discussionmentioning

confidence: 99%

“…Proton radiotherapy has been used for reirradiation for relapsed ependymoma with good efficacy (3-year overall survival and progression-free survival are reported as 78.6% and 28.1%, respectively) and reasonable toxicity with 21.4% of locally retreated patients having experienced grade 2 radiation-associated treatment change. [42] Medulloblastoma Medulloblastoma is the most common malignant brain tumor in children and presents at a median age of 5-7 years. These tumors have a propensity to spread throughout the neuroaxis with 26-32% presenting with metastatic disease at diagnosis.…”

Section: Ependymomamentioning

confidence: 99%

Radiosurgery for Pediatric Brain Tumors

Murphy

Chao

Angelov

et al. 2015

Pediatr Blood Cancer

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The utility of radiosurgery for pediatric brain tumors is not well known. For children, radiosurgery may have an important role for treating unresectable tumors, residual disease, or tumors in the recurrent setting that have received prior radiotherapy. The available evidence demonstrates utility for some children with primary brain tumors resulting in good local control. Radiosurgery can be considered for limited residual disease or focal recurrences. However, the potential toxicities are unique and not insignificant. Therefore, prospective studies need to be performed to develop guidelines for indications and treatment for children and reduce toxicity in this population.

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Use of proton therapy for re-irradiation in pediatric intracranial ependymoma

Cited by 61 publications

References 18 publications

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

Repeat irradiation for children with supratentorial high‐grade glioma

Radiosurgery for Pediatric Brain Tumors

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