Pulmonary Function After Treatment for Embryonal Brain Tumors on SJMB03 That Included Craniospinal Irradiation
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (United States)
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee (United States)
- Department of Pediatrics, University of Tennessee School of Medicine, Memphis, Tennessee (United States)
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (United States)
- Department of Haematology and Oncology, The Hospital for Sick Children, Toronto, Ontario (Canada)
- Department of Pediatric Medicine, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas (United States)
- Department of Haematology and Oncology, Royal Children's Hospital, Brisbane (Australia)
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (United States)
- Department of Pediatrics, Children's Hospital at Westmead, Sydney (Australia)
- Children's Cancer Center, Royal Children's Hospital Melbourne, Melbourne (Australia)
- Department of Clinical Oncology, Sydney Children's Hospital, Sydney (Australia)
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (United States)
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee (United States)
Purpose: The treatment of children with embryonal brain tumors (EBT) includes craniospinal irradiation (CSI). There are limited data regarding the effect of CSI on pulmonary function. Methods: Protocol SJMB03 enrolled patients 3 to 21 years of age with EBT. Pulmonary function tests (PFTs) (forced expiratory volume in 1 second [FEV{sub 1}] and forced vital capacity [FVC] by spirometry, total lung capacity [TLC] by nitrogen washout or plethysmography, and diffusing capacity of the lung for carbon monoxide corrected for hemoglobin [DLCO{sub corr}]) were obtained. Differences between PFTs obtained immediately after the completion of CSI and 24 or 60 months after the completion of treatment (ACT) were compared using exact Wilcoxon signed-rank tests and repeated-measures models. Results: Between June 24, 2003, and March 1, 2010, 303 eligible patients (spine dose: ≤2345 cGy, 201; >2345 cGy, 102; proton beam, 20) were enrolled, 260 of whom had at least 1 PFT. The median age at diagnosis was 8.9 years (range, 3.1-20.4 years). The median thoracic spinal radiation dose was 23.4 Gy (interquartile range [IQR], 23.4-36.0 Gy). The median cyclophosphamide dose was 16.0 g/m{sup 2} (IQR, 15.7-16.0 g/m{sup 2}). At 24 and 60 months ACT, DLCO{sub corr} was <75% predicted in 23% (27/118) and 25% (21/84) of patients, FEV{sub 1} was <80% predicted in 20% (34/170) and 29% (32/109) of patients, FVC was <80% predicted in 27% (46/172) and 28% (30/108) of patients, and TLC was <75% predicted in 9% (13/138) and 11% (10/92) of patients. DLCO{sub corr} was significantly decreased 24 months ACT (median difference [MD] in % predicted, 3.00%; P=.028) and 60 months ACT (MD in % predicted, 6.00%; P=.033) compared with the end of radiation therapy. These significant decreases in DLCO{sub corr} were also observed in repeated-measures models (P=.011 and P=.032 at 24 and 60 months ACT, respectively). Conclusions: A significant minority of EBT survivors experience PFT deficits after CSI. Continued monitoring of this cohort is planned.
- OSTI ID:
- 22458747
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 93, Issue 1; Other Information: Copyright (c) 2015 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
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