Local control after craniospinal irradiation, intensity-modulated radiotherapy boost, and chemotherapy in childhood medulloblastoma

Authors

  • Arnold C. Paulino MD,

    Corresponding author
    1. Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, Texas
    2. Department of Pediatrics, Division of Pediatric Hematology/Oncology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
    • Department of Radiation Oncology, The Methodist Hospital, 6565 Fannin Street, DB1-077, Houston, TX 77030
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    • Fax: (713) 441-4493

  • Ali Mazloom MD,

    1. Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, Texas
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  • Bin S. Teh MD,

    1. Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, Texas
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  • Michael South CMD,

    1. Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, Texas
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  • M. Fatih Okcu MD, MP,

    1. Department of Pediatrics, Division of Pediatric Hematology/Oncology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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  • Jack Su MD,

    1. Department of Pediatrics, Division of Pediatric Hematology/Oncology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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  • E. Brian Butler MD,

    1. Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, Texas
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  • Murali Chintagumpala MD

    1. Department of Pediatrics, Division of Pediatric Hematology/Oncology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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  • Presented in part at the 51st Annual Meeting of the American Society of Radiation Oncology; Chicago, Illinois; November 1-5, 2009.

Abstract

BACKGROUND:

The current study was conducted to determine whether the use of cochlear-sparing intensity-modulated radiotherapy (IMRT) boost results in excess local failures in children with medulloblastoma.

METHODS:

Fifty children with a median age of 7.8 years underwent resection, craniospinal irradiation (CSI), IMRT posterior fossa (PF) and/or tumor bed (TB) boost, and cisplatin-based chemotherapy for medulloblastoma. For standard-risk patients, the CSI dose was 18 to 23.4 grays (Gy) and was followed either by an IMRT PF boost to 36 Gy and a TB boost of 54 to 55.8 Gy (n = 29) or by an IMRT TB boost to 55.8 Gy (n = 4). For high-risk patients, the CSI dose was 36 to 39.6 Gy followed by an IMRT PF boost to 54 to 55.8 Gy (n = 8), an IMRT PF boost to 45 Gy and a TB boost to 55.8 Gy (n = 2), or an IMRT TB boost to 55.8 Gy (n = 7). For the TB boost, a 2-cm margin around the surgical bed was treated in most patients.

RESULTS:

The 5-year overall and progression-free survival rates (±standard deviation) were 72% ± 6.6% and 68.3% ± 6.8%, respectively, for all patients; 77.8% ± 7.4% and 75.1% ± 7.6%, respectively, for standard-risk patients; and 60.8% ± 12.8% and 55.4% ± 12.8%, respectively, for high-risk patients. The 5-year PF control rate was 90.5% ± 4.6%. TB failures occurred in 3 patients (including 2 patients who had distant failure), whereas an isolated non-TB PF failure occurred in 1 patient.

CONCLUSIONS:

The use of IMRT was associated with excellent local control and did not result in excess PF failures outside of the TB. Cancer 2011. © 2010 American Cancer Society.

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