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

  1. Arnold C. Paulino MD1,2,‡,*,
  2. Ali Mazloom MD1,
  3. Bin S. Teh MD1,
  4. Michael South CMD1,
  5. M. Fatih Okcu MD, MP2,
  6. Jack Su MD2,
  7. E. Brian Butler MD1,
  8. Murali Chintagumpala MD2

Article first published online: 15 SEP 2010

DOI: 10.1002/cncr.25601

Issue

Cancer

Cancer

Volume 117, Issue 3, pages 635–641, 1 February 2011

Additional Information

How to Cite

Paulino, A. C., Mazloom, A., Teh, B. S., South, M., Okcu, M. F., Su, J., Butler, E. B. and Chintagumpala, M. (2011), Local control after craniospinal irradiation, intensity-modulated radiotherapy boost, and chemotherapy in childhood medulloblastoma. Cancer, 117: 635–641. doi: 10.1002/cncr.25601

Author Information

  1. 1

    Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, Texas

  2. 2

    Department of Pediatrics, Division of Pediatric Hematology/Oncology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas

  1. ‡

    Fax: (713) 441-4493

*Department of Radiation Oncology, The Methodist Hospital, 6565 Fannin Street, DB1-077, Houston, TX 77030

  1. †

    Presented in part at the 51st Annual Meeting of the American Society of Radiation Oncology; Chicago, Illinois; November 1-5, 2009.

Publication History

  1. Issue published online: 20 JAN 2011
  2. Article first published online: 15 SEP 2010
  3. Manuscript Revised: 28 JUL 2010
  4. Manuscript Accepted: 28 JUL 2010
  5. Manuscript Received: 23 MAY 2010

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Keywords:

  • intensity-modulated radiotherapy;
  • medulloblastoma;
  • local control;
  • radiotherapy;
  • pediatric brain tumor

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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