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Title: Imaging Changes in Pediatric Intracranial Ependymoma Patients Treated With Proton Beam Radiation Therapy Compared to Intensity Modulated Radiation Therapy

Purpose: The clinical significance of magnetic resonance imaging (MRI) changes after radiation therapy (RT) in children with ependymoma is not well defined. We compared imaging changes following proton beam radiation therapy (PBRT) to those after photon-based intensity modulated RT (IMRT). Methods and Materials: Seventy-two patients with nonmetastatic intracranial ependymoma who received postoperative RT (37 PBRT, 35 IMRT) were analyzed retrospectively. MRI images were reviewed by 2 neuroradiologists. Results: Sixteen PBRT patients (43%) developed postradiation MRI changes at 3.8 months (median) with resolution by 6.1 months. Six IMRT patients (17%) developed changes at 5.3 months (median) with 8.3 months to resolution. Mean age at radiation was 4.4 and 6.9 years for PBRT and IMRT, respectively (P=.06). Age at diagnosis (>3 years) and time of radiation (≥3 years) was associated with fewer imaging changes on univariate analysis (odds ratio [OR]: 0.35, P=.048; OR: 0.36, P=.05). PBRT (compared to IMRT) was associated with more frequent imaging changes, both on univariate (OR: 3.68, P=.019) and multivariate (OR: 3.89, P=.024) analyses. Seven (3 IMRT, 4 PBRT) of 22 patients with changes had symptoms requiring intervention. Most patients were treated with steroids; some PBRT patients also received bevacizumab and hyperbaric oxygen therapy. None of the IMRT patients had lasting deficits, but 2 patients diedmore » from recurrent disease. Three PBRT patients had persistent neurological deficits, and 1 child died secondarily to complications from radiation necrosis. Conclusions: Postradiation MRI changes are more common with PBRT and in patients less than 3 years of age at diagnosis and treatment. It is difficult to predict causes for development of imaging changes that progress to clinical significance. These changes are usually self-limiting, but some require medical intervention, especially those involving the brainstem.« less
Authors:
 [1] ; ;  [2] ;  [3] ;  [4] ;  [1] ;  [1] ;  [5] ; ;  [2] ;  [6] ;  [1] ;  [7] ;  [8] ; ;  [9] ;  [1]
  1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer Center, Houston, Texas (United States)
  3. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  4. Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas (United States)
  5. (United States)
  6. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  7. Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  8. Department of Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas (United States)
  9. Department of Neurosurgery, Texas Children's Hospital, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
22458748
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 93; Journal 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)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; CHILDREN; COMPARATIVE EVALUATIONS; DIAGNOSIS; DISEASES; MULTIVARIATE ANALYSIS; NECROSIS; NMR IMAGING; OXYGEN; PATIENTS; PEDIATRICS; PHOTONS; PROTON BEAMS; RADIOTHERAPY; REVIEWS; STEROIDS; SYMPTOMS