No Salvage Using High-Dose Chemotherapy Plus/Minus Reirradiation for Relapsing Previously Irradiated Medulloblastoma
- Division of Pediatrics, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)
- Division of Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)
- Division of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)
- Neurosurgery II, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan (Italy)
- Division of Physics, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)
- Acquired Lesion Unit, Eugenio Medea Institute, Bosisio Parini (Italy)
- Division of Cytogenetics, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)
- Division of Statistics, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)
- Division of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)
- Pediatric Neurosurgery Unit, San Raffaele Hospital, Milan (Italy)
Purpose: Myeloablative regimens were frequently used for medulloblastoma relapsing after craniospinal irradiation (CSI): in 1997-2002, we used repeated surgery, standard-dose and myeloablative chemotherapy, and reirradiation. Methods and Materials: In 10 patients, reinduction included sequential high-dose etoposide, high-dose cyclophosphamide/vincristine, and high-dose carboplatin/vincristine, then two myeloablative courses with high-dose thiotepa ({+-} carboplatin); 6 other patients received two of four courses of cisplatin/etoposide. Hematopoietic precursor mobilization followed high-dose etoposide or high-dose cyclophosphamide or cisplatin/etoposide therapy. After the overall chemotherapy program, reirradiation was prescribed when possible. Results: Seventeen patients were treated: previous treatment included CSI of 19.5-36 Gy with posterior fossa/tumor boost and chemotherapy in 16 patients. Fifteen patients were in their first and 2 in their second and third relapses, respectively. First progression-free survival had lasted a median of 26 months. Relapse sites included leptomeninges in 9 patients, spine in 4 patients, posterior fossa in 3 patients, and brain in 1 patient. Three patients underwent complete resection of recurrence, and 10 underwent reirradiation. Twelve of 14 patients with assessable tumor had an objective response after reinduction; 2 experienced progression and were not given the myeloablative courses. Remission lasted a median of 16 months. Additional relapses appeared in 13 patients continuing the treatment. Fifteen patients died of progression and 1 died of pneumonia 13 months after relapse. The only survivor at 93 months had a single spinal metastasis that was excised and irradiated. Survival for the series as a whole was 11-93 months, with a median of 41 months. Conclusions: Despite responses being obtained and ample use of surgery and reirradiation, second-line therapy with myeloablative schedules was not curative, barring a few exceptions. A salvage therapy for medulloblastoma after CSI still needs to be sought.
- OSTI ID:
- 21276730
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 73, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2008.06.1930; PII: S0360-3016(08)02972-6; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
Similar Records
Postponed Is Not Canceled: Role of Craniospinal Radiation Therapy in the Management of Recurrent Infant Medulloblastoma—An Experience From the HIT-REZ 1997 and 2005 Studies
Multi-Institution Prospective Trial of Reduced-Dose Craniospinal Irradiation (23.4 Gy) Followed by Conformal Posterior Fossa (36 Gy) and Primary Site Irradiation (55.8 Gy) and Dose-Intensive Chemotherapy for Average-Risk Medulloblastoma