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Craniospinal irradiation as part of re-irradiation for children with recurrent medulloblastoma
Journal of Neuro-Oncology ( IF 3.9 ) Pub Date : 2021-09-09 , DOI: 10.1007/s11060-021-03842-3
Lorena V Baroni 1 , Candela Freytes 1 , Nicolás Fernández Ponce 1 , Agustina Oller 1 , Natalia Pinto 2 , Adriana Gonzalez 3 , Francisco R Maldonado 4 , Claudia Sampor 1 , Carlos Rugilo 4 , Fabiana Lubieniecki 5 , Daniel Alderete 1
Affiliation  

Background

Many studies have demonstrated in the last years that once medulloblastoma has recurred, the probability of regaining tumor control is poor despite salvage therapy. Although re-irradiation has an emerging role in other relapsed brain tumors, there is a lack of strong data on re-irradiation for medulloblastoma.

Methods

This is a retrospective cohort study of patients aged 18 years or under, treated at least by a second course of external beam for recurrence medulloblastoma at Garrahan Hospital between 2009 and 2020. Twenty-four patients met eligibility criteria for inclusion. All patients received upfront radiotherapy as part of the curative-intent first radiotherapy, either craniospinal irradiation (CSI) followed by posterior fossa boost in 20 patients or focal posterior fossa radiation in 4 infants. The second course of radiation consisted of CSI in 15 and focal in 9. The 3-year post first failure OS (50% vs. 0%; p = 0.0010) was significantly better for children who received re-CSI compared to children who received focal re-irradiation. Similarly, the 3-year post-re-RT PFS (31% vs. 0%; p = 0.0005) and OS (25% vs. 0%; p = 0.0003) was significantly improved for patients who received re-CSI compared to patients who received focal re-irradiation. No symptomatic intratumoral haemorrhagic events or symptomatic radionecrosis were observed. Survivors fell within mild to moderate intellectual disability range, with a median IQ at last assessment of 58 (range 43–69).

Conclusions

Re-irradiation with CSI is a safe and effective treatment for children with relapsed medulloblastoma; improves disease control and survival compared with focal re-irradiation. However this approach carries a high neurocognitive cost.



中文翻译:

颅脊髓照射作为复发性髓母细胞瘤儿童再照射的一部分

背景

过去几年的许多研究表明,一旦髓母细胞瘤复发,尽管进行了抢救治疗,恢复肿瘤控制的可能性仍然很低。尽管再照射在其他复发性脑肿瘤中具有新兴作用,但缺乏关于髓母细胞瘤再照射的有力数据。

方法

这是一项回顾性队列研究,对象为 2009 年至 2020 年间在 Garrahan 医院接受至少第二疗程外照射治疗复发髓母细胞瘤的 18 岁或以下患者。24 名患者符合入选标准。所有患者都接受了前期放射治疗,作为以治愈为目的的首次放射治疗的一部分,20 名患者接受颅脊髓照射 (CSI),然后是后颅窝加强放疗,或者 4 名婴儿接受局灶后颅窝放疗。第二个疗程包括 15 例 CSI 和 9 例局灶性放疗。第一次失败后 3 年的 OS(50% 对 0%;p = 0.0010)对于接受重新 CSI 的儿童与接受焦点再照射。同样,再 RT 后 3 年 PFS(31% 对 0%;p = 0.0005)和 OS(25% 对 0%;p = 0。0003) 与接受局部再照射的患者相比,接受再 CSI 的患者显着改善。未观察到有症状的瘤内出血事件或有症状的放射性坏死。幸存者属于轻度至中度智力障碍范围,最后评估的平均智商为 58(范围 43-69)。

结论

对复发性髓母细胞瘤患儿进行 CSI 再照射是一种安全有效的治疗方法;与局部再照射相比,可改善疾病控制和存活率。然而,这种方法具有很高的神经认知成本。

更新日期:2021-09-10
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