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Title: Disease Control and Ototoxicity Using Intensity-Modulated Radiation Therapy Tumor-Bed Boost for Medulloblastoma

Abstract

Purpose: We previously reported excellent local control for treating medulloblastoma with a limited boost to the tumor bed. In order to decrease ototoxicity, we subsequently implemented a tumor-bed boost using intensity-modulated radiation therapy (IMRT), the clinical results of which we report here. Patients and Methods: A total of 33 patients with newly diagnosed medulloblastoma, 25 with standard risk, and 8 with high risk, were treated on an IMRT tumor-bed boost following craniospinal irradiation (CSI). Six standard-risk patients were treated with an institutional protocol with 18 Gy CSI in conjunction with intrathecal iodine-131-labeled monoclonal antibody. The majority of patients received concurrent vincristine and standard adjuvant chemotherapy. Pure-tone audiograms were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: Median age was 9 years old (range, 4-46 years old). Median follow-up was 63 months. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) rates for standard-risk patients who received 23.4 or 36 Gy CSI (not including those who received 18 Gy CSI with radioimmunotherapy) were 81.4% and 88.4%, respectively, at 5 years; 5-year PFS and OS rates for high-risk patients were both 87.5%. There were no isolated posterior fossa failures outside of the boost volume.more » Posttreatment audiograms were available for 31 patients, of whom 6%, at a median follow-up of 19 months, had developed Grade 3 hearing loss. Conclusion: An IMRT tumor-bed boost results in excellent local control while delivering a low mean dose to the cochlea, resulting in a low rate of ototoxicity.« less

Authors:
 [1];  [2];  [3]; ; ; ;  [2];  [4]
  1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States)
  2. Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States)
  3. Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States)
  4. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States)
Publication Date:
OSTI Identifier:
21590418
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 81; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2010.11.081; PII: S0360-3016(11)00133-7; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; HAZARDS; IODINE 131; IRRADIATION; MONOCLONAL ANTIBODIES; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOIMMUNOTHERAPY; ANTIBODIES; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; DAYS LIVING RADIOISOTOPES; DISEASES; DOSES; IMMUNOTHERAPY; INTERMEDIATE MASS NUCLEI; IODINE ISOTOPES; ISOTOPES; MEDICINE; NUCLEAR MEDICINE; NUCLEI; ODD-EVEN NUCLEI; RADIOISOTOPES; RADIOLOGY; RADIOTHERAPY; THERAPY

Citation Formats

Polkinghorn, William R, Dunkel, Ira J, Souweidane, Mark M, Khakoo, Yasmin, Lyden, David C, Gilheeney, Stephen W, Becher, Oren J, Budnick, Amy S, and Wolden, Suzanne L., E-mail: woldens@mskcc.org. Disease Control and Ototoxicity Using Intensity-Modulated Radiation Therapy Tumor-Bed Boost for Medulloblastoma. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.11.081.
Polkinghorn, William R, Dunkel, Ira J, Souweidane, Mark M, Khakoo, Yasmin, Lyden, David C, Gilheeney, Stephen W, Becher, Oren J, Budnick, Amy S, & Wolden, Suzanne L., E-mail: woldens@mskcc.org. Disease Control and Ototoxicity Using Intensity-Modulated Radiation Therapy Tumor-Bed Boost for Medulloblastoma. United States. https://doi.org/10.1016/j.ijrobp.2010.11.081
Polkinghorn, William R, Dunkel, Ira J, Souweidane, Mark M, Khakoo, Yasmin, Lyden, David C, Gilheeney, Stephen W, Becher, Oren J, Budnick, Amy S, and Wolden, Suzanne L., E-mail: woldens@mskcc.org. 2011. "Disease Control and Ototoxicity Using Intensity-Modulated Radiation Therapy Tumor-Bed Boost for Medulloblastoma". United States. https://doi.org/10.1016/j.ijrobp.2010.11.081.
@article{osti_21590418,
title = {Disease Control and Ototoxicity Using Intensity-Modulated Radiation Therapy Tumor-Bed Boost for Medulloblastoma},
author = {Polkinghorn, William R and Dunkel, Ira J and Souweidane, Mark M and Khakoo, Yasmin and Lyden, David C and Gilheeney, Stephen W and Becher, Oren J and Budnick, Amy S and Wolden, Suzanne L., E-mail: woldens@mskcc.org},
abstractNote = {Purpose: We previously reported excellent local control for treating medulloblastoma with a limited boost to the tumor bed. In order to decrease ototoxicity, we subsequently implemented a tumor-bed boost using intensity-modulated radiation therapy (IMRT), the clinical results of which we report here. Patients and Methods: A total of 33 patients with newly diagnosed medulloblastoma, 25 with standard risk, and 8 with high risk, were treated on an IMRT tumor-bed boost following craniospinal irradiation (CSI). Six standard-risk patients were treated with an institutional protocol with 18 Gy CSI in conjunction with intrathecal iodine-131-labeled monoclonal antibody. The majority of patients received concurrent vincristine and standard adjuvant chemotherapy. Pure-tone audiograms were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: Median age was 9 years old (range, 4-46 years old). Median follow-up was 63 months. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) rates for standard-risk patients who received 23.4 or 36 Gy CSI (not including those who received 18 Gy CSI with radioimmunotherapy) were 81.4% and 88.4%, respectively, at 5 years; 5-year PFS and OS rates for high-risk patients were both 87.5%. There were no isolated posterior fossa failures outside of the boost volume. Posttreatment audiograms were available for 31 patients, of whom 6%, at a median follow-up of 19 months, had developed Grade 3 hearing loss. Conclusion: An IMRT tumor-bed boost results in excellent local control while delivering a low mean dose to the cochlea, resulting in a low rate of ototoxicity.},
doi = {10.1016/j.ijrobp.2010.11.081},
url = {https://www.osti.gov/biblio/21590418}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 81,
place = {United States},
year = {Tue Nov 01 00:00:00 EDT 2011},
month = {Tue Nov 01 00:00:00 EDT 2011}
}