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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]
  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. 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., and Wolden, Suzanne L., E-mail: woldens@mskcc.org. Tue . "Disease Control and Ototoxicity Using Intensity-Modulated Radiation Therapy Tumor-Bed Boost for Medulloblastoma". United States. doi: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},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 81,
place = {United States},
year = {2011},
month = {11}
}