Postponed is not canceled: role of craniospinal radiation therapy in the management of recurrent infant medulloblastoma--an experience from the HIT-REZ 1997 & 2005 studies

TY - JOUR

T1 - Postponed is not canceled: role of craniospinal radiation therapy in the management of recurrent infant medulloblastoma--an experience from the HIT-REZ 1997 & 2005 studies

AU - Müller, Klaus

AU - Mynarek, Martin

AU - Zwiener, Isabella

AU - Siegler, Nele

AU - Zimmermann, Martina

AU - Christiansen, Hans

AU - Budach, Wilfried

AU - Henke, Guido

AU - Warmuth-Metz, Monika

AU - Pietsch, Torsten

AU - von Hoff, Katja

AU - von Bueren, Andre

AU - Bode, Udo

AU - Rutkowski, Stefan

AU - Kortmann, Rolf-Dieter

AU - Fleischhack, Gudrun

AU - Tippelt, Stephan

N1 - Copyright © 2014 Elsevier Inc. All rights reserved.

PY - 2014/4/1

Y1 - 2014/4/1

N2 - PURPOSE: To evaluate the efficacy of craniospinal irradiation (CSI) in the management of recurrent infant medulloblastoma after surgery and chemotherapy alone.METHODS AND MATERIALS: Seventeen pediatric medulloblastoma patients registered in the HIT-REZ 1997 and 2005 studies underwent CSI as salvage treatment at first recurrence. All patients had achieved complete remission after first-line treatment consisting of surgery and chemotherapy. Eleven patients showed metastatic disease at relapse. Five patients underwent surgery prior to radiation therapy, which resulted in complete resection in 1 case. In 1 patient, complete resection of the residual tumor was performed after CSI. Eleven patients received chemotherapy prior, 6 patients during and 8 patients after CSI. All patients received CSI with a median total dose of 35.2 Gy, and all but 1 received a boost to the posterior fossa (median total dose, 55.0 Gy). Metastases were boosted with an individual radiation dose, depending on their location and extent.RESULTS: During a median follow-up time of 6.2 years since recurrence, 11 patients showed progressive disease and died. Median progression-free (overall) survival was 2.9 ± 1.1 (3.8 ± 0.8) years. Progression-free survival (PFS) rates at 1, 3, and 5 years were 88% ± 8%, 46% ± 12%, and 40% ± 12%, respectively. Overall survival (OS) rates at 1, 3, and 5 years were 94% ± 6%, 58% ± 12%, and 39% ± 12%, respectively. For 11 patients with classic medulloblastoma, 3-year (and 5-year) PFS and OS were 62% ± 15% and 72% ± 14% (52% ± 16% and 51% ± 16%), respectively. On univariate analysis, metastatic disease was not associated with poorer progression-free and overall survival.CONCLUSIONS: Our results suggest that salvage treatment of relapsed medulloblastomas consisting of CSI and chemotherapy offers a second chance for cure, even for patients with classic histological findings. Metastatic disease at relapse did not have an impact on survival. However, this may be explained by the small number of patients.

AB - PURPOSE: To evaluate the efficacy of craniospinal irradiation (CSI) in the management of recurrent infant medulloblastoma after surgery and chemotherapy alone.METHODS AND MATERIALS: Seventeen pediatric medulloblastoma patients registered in the HIT-REZ 1997 and 2005 studies underwent CSI as salvage treatment at first recurrence. All patients had achieved complete remission after first-line treatment consisting of surgery and chemotherapy. Eleven patients showed metastatic disease at relapse. Five patients underwent surgery prior to radiation therapy, which resulted in complete resection in 1 case. In 1 patient, complete resection of the residual tumor was performed after CSI. Eleven patients received chemotherapy prior, 6 patients during and 8 patients after CSI. All patients received CSI with a median total dose of 35.2 Gy, and all but 1 received a boost to the posterior fossa (median total dose, 55.0 Gy). Metastases were boosted with an individual radiation dose, depending on their location and extent.RESULTS: During a median follow-up time of 6.2 years since recurrence, 11 patients showed progressive disease and died. Median progression-free (overall) survival was 2.9 ± 1.1 (3.8 ± 0.8) years. Progression-free survival (PFS) rates at 1, 3, and 5 years were 88% ± 8%, 46% ± 12%, and 40% ± 12%, respectively. Overall survival (OS) rates at 1, 3, and 5 years were 94% ± 6%, 58% ± 12%, and 39% ± 12%, respectively. For 11 patients with classic medulloblastoma, 3-year (and 5-year) PFS and OS were 62% ± 15% and 72% ± 14% (52% ± 16% and 51% ± 16%), respectively. On univariate analysis, metastatic disease was not associated with poorer progression-free and overall survival.CONCLUSIONS: Our results suggest that salvage treatment of relapsed medulloblastomas consisting of CSI and chemotherapy offers a second chance for cure, even for patients with classic histological findings. Metastatic disease at relapse did not have an impact on survival. However, this may be explained by the small number of patients.

KW - Brain Neoplasms

KW - Child

KW - Child, Preschool

KW - Cohort Studies

KW - Cranial Irradiation

KW - Disease-Free Survival

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Infant

KW - Male

KW - Medulloblastoma

KW - Multivariate Analysis

KW - Neoplasm Metastasis

KW - Neoplasm Recurrence, Local

KW - Neoplasm Staging

KW - Proportional Hazards Models

KW - Radiotherapy Dosage

KW - Recurrence

KW - Salvage Therapy

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.ijrobp.2014.01.013

DO - 10.1016/j.ijrobp.2014.01.013

M3 - SCORING: Journal article

C2 - 24661654

VL - 88

SP - 1019

EP - 1024

JO - INT J RADIAT ONCOL

JF - INT J RADIAT ONCOL

SN - 0360-3016

IS - 5

ER -