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Title: Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review

Abstract

Purpose: Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients. Methods and Materials: The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed. Results: Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n=20; 30%), ependymoma (n=19; 28%), germ cell tumor (n=8; 12%), high-grade glioma (n=9; 13%), low-grade glioma (n=5; 7%), and other (n=6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n=46), 3-dimensional conformalmore » RT (n=9), stereotactic radiosurgery (n=4; 12-13 Gy × 1 or 5 Gy × 5), protons (n=4), combined modality (n=3), 2-dimensional RT (n=1), and brachytherapy (n=1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively. Conclusions: CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.« less

Authors:
; ;  [1];  [2];  [3];  [4];  [5];  [3];  [6];  [1];  [7];  [1];  [6];  [7];
  1. Department of Radiation and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Medicine, Baltimore, Maryland (United States)
  2. Department of Radiation Oncology, Centro Infantil Boldrini, São Paulo (Brazil)
  3. Department of Radiation Oncology, Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology, Moscow (Russian Federation)
  4. Department of Radiation Oncology, Uppsala University Hospital, Uppsala (Sweden)
  5. Department of Radiation Oncology, Universitätklinik Für Strahlentherapie und Strahlenbiologie, Wien (Germany)
  6. Department of Radiation Oncology, University of Washington, Seattle, Washington (United States)
  7. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)
Publication Date:
OSTI Identifier:
22723030
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 99; Journal Issue: 3; Other Information: Copyright (c) 2017 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; CENTRAL NERVOUS SYSTEM; PATIENTS; PEDIATRICS; RADIATION DOSES; REVIEWS

Citation Formats

Rao, Avani D., Rashid, Arif S., Chen, Qinyu, Villar, Rosangela C., Kobyzeva, Daria, Nilsson, Kristina, Dieckmann, Karin, Nechesnyuk, Alexey, Ermoian, Ralph, Alcorn, Sara, MacDonald, Shannon M., Ladra, Matthew M., Ford, Eric C., Winey, Brian A., and others, and. Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.07.026.
Rao, Avani D., Rashid, Arif S., Chen, Qinyu, Villar, Rosangela C., Kobyzeva, Daria, Nilsson, Kristina, Dieckmann, Karin, Nechesnyuk, Alexey, Ermoian, Ralph, Alcorn, Sara, MacDonald, Shannon M., Ladra, Matthew M., Ford, Eric C., Winey, Brian A., & others, and. Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review. United States. doi:10.1016/J.IJROBP.2017.07.026.
Rao, Avani D., Rashid, Arif S., Chen, Qinyu, Villar, Rosangela C., Kobyzeva, Daria, Nilsson, Kristina, Dieckmann, Karin, Nechesnyuk, Alexey, Ermoian, Ralph, Alcorn, Sara, MacDonald, Shannon M., Ladra, Matthew M., Ford, Eric C., Winey, Brian A., and others, and. Wed . "Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review". United States. doi:10.1016/J.IJROBP.2017.07.026.
@article{osti_22723030,
title = {Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review},
author = {Rao, Avani D. and Rashid, Arif S. and Chen, Qinyu and Villar, Rosangela C. and Kobyzeva, Daria and Nilsson, Kristina and Dieckmann, Karin and Nechesnyuk, Alexey and Ermoian, Ralph and Alcorn, Sara and MacDonald, Shannon M. and Ladra, Matthew M. and Ford, Eric C. and Winey, Brian A. and others, and},
abstractNote = {Purpose: Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients. Methods and Materials: The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed. Results: Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n=20; 30%), ependymoma (n=19; 28%), germ cell tumor (n=8; 12%), high-grade glioma (n=9; 13%), low-grade glioma (n=5; 7%), and other (n=6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n=46), 3-dimensional conformal RT (n=9), stereotactic radiosurgery (n=4; 12-13 Gy × 1 or 5 Gy × 5), protons (n=4), combined modality (n=3), 2-dimensional RT (n=1), and brachytherapy (n=1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively. Conclusions: CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.},
doi = {10.1016/J.IJROBP.2017.07.026},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 99,
place = {United States},
year = {2017},
month = {11}
}