Radiotherapy for Recurrent Medulloblastoma in Children and Adolescents: Survival after Re-Irradiation and First-Time Irradiation

  • Jonas E Adolph
  • Gudrun Fleischhack
  • Sebastian Tschirner
  • Lydia Rink
  • Christine Dittes
  • Ruth Mikasch
  • Philipp Dammann
  • Martin Mynarek
  • Denise Obrecht-Sturm
  • Stefan Rutkowski
  • Brigitte Bison
  • Monika Warmuth-Metz
  • Torsten Pietsch
  • Stefan M Pfister
  • Kristian W Pajtler
  • Till Milde
  • Rolf-Dieter Kortmann
  • Stefan Dietzsch
  • Beate Timmermann
  • Stephan Tippelt
  • German GPOH HIT-Network

Abstract

BACKGROUND: Radiotherapy (RT) involving craniospinal irradiation (CSI) is important in the initial treatment of medulloblastoma. At recurrence, the re-irradiation options are limited and associated with severe side-effects.

METHODS: For pre-irradiated patients, patients with re-irradiation (RT2) were matched by sex, histology, time to recurrence, disease status and treatment at recurrence to patients without RT2.

RESULTS: A total of 42 pre-irradiated patients with RT2 were matched to 42 pre-irradiated controls without RT2. RT2 improved the median PFS [21.0 (CI: 15.7-28.7) vs. 12.0 (CI: 8.1-21.0) months] and OS [31.5 (CI: 27.6-64.8) vs. 20.0 (CI: 14.0-36.7) months]. Concerning long-term survival after ten years, RT2 only lead to small improvements in OS [8% (CI: 1.4-45.3) vs. 0%]. RT2 improved survival most without (re)-resection [PFS: 17.5 (CI: 9.7-41.5) vs. 8.0 (CI: 6.6-12.2)/OS: 31.5 (CI: 27.6-NA) vs. 13.3 (CI: 8.1-20.1) months]. In the RT-naïve patients, CSI at recurrence improved their median PFS [25.0 (CI: 16.8-60.6) vs. 6.6 (CI: 1.5-NA) months] and OS [40.2 (CI: 18.7-NA) vs. 12.4 (CI: 4.4-NA) months].

CONCLUSIONS: RT2 could improve the median survival in a matched cohort but offered little benefit regarding long-term survival. In RT-naïve patients, CSI greatly improved their median and long-term survival.

Bibliografische Daten

OriginalspracheEnglisch
Aufsatznummer1955
ISSN2072-6694
DOIs
StatusVeröffentlicht - 22.05.2024
PubMed 38893076