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. 2021 Oct;155(1):53-61.
doi: 10.1007/s11060-021-03842-3. Epub 2021 Sep 9.

Craniospinal irradiation as part of re-irradiation for children with recurrent medulloblastoma

Lorena V Baroni  1 , Candela Freytes  2 , Nicolás Fernández Ponce  2 , Agustina Oller  2 , Natalia Pinto  3 , Adriana Gonzalez  4 , Francisco R Maldonado  5 , Claudia Sampor  2 , Carlos Rugilo  5 , Fabiana Lubieniecki  6 , Daniel Alderete  7
Affiliations

Craniospinal irradiation as part of re-irradiation for children with recurrent medulloblastoma

Lorena V Baroni et al. J Neurooncol. 2021 Oct.

Abstract

Background: Many studies have demonstrated in the last years that once medulloblastoma has recurred, the probability of regaining tumor control is poor despite salvage therapy. Although re-irradiation has an emerging role in other relapsed brain tumors, there is a lack of strong data on re-irradiation for medulloblastoma.

Methods: This is a retrospective cohort study of patients aged 18 years or under, treated at least by a second course of external beam for recurrence medulloblastoma at Garrahan Hospital between 2009 and 2020. Twenty-four patients met eligibility criteria for inclusion. All patients received upfront radiotherapy as part of the curative-intent first radiotherapy, either craniospinal irradiation (CSI) followed by posterior fossa boost in 20 patients or focal posterior fossa radiation in 4 infants. The second course of radiation consisted of CSI in 15 and focal in 9. The 3-year post first failure OS (50% vs. 0%; p = 0.0010) was significantly better for children who received re-CSI compared to children who received focal re-irradiation. Similarly, the 3-year post-re-RT PFS (31% vs. 0%; p = 0.0005) and OS (25% vs. 0%; p = 0.0003) was significantly improved for patients who received re-CSI compared to patients who received focal re-irradiation. No symptomatic intratumoral haemorrhagic events or symptomatic radionecrosis were observed. Survivors fell within mild to moderate intellectual disability range, with a median IQ at last assessment of 58 (range 43-69).

Conclusions: Re-irradiation with CSI is a safe and effective treatment for children with relapsed medulloblastoma; improves disease control and survival compared with focal re-irradiation. However this approach carries a high neurocognitive cost.

Keywords: Medulloblastoma; Radiotherapy; Re-irradiation; Relapse.

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References

    1. Koschmann C, Bloom K, Upadhyaya S, Geyer JR, Leary SE (2016) Survival after relapse of medulloblastoma. J Pediatr Hematol Oncol 38(4):269–273. https://doi.org/10.1097/MPH.0000000000000547 - DOI - PubMed
    1. Sabel M, Fleischhack G, Tippelt S, SIOP-E Brain Tumour Group et al (2016) Relapse patterns and outcome after relapse in standard risk medulloblastoma: a report from the HIT-SIOP-PNET4 study. J Neurooncol 129(3):515–524. https://doi.org/10.1007/s11060-016-2202-1 - DOI - PubMed - PMC
    1. Johnston DL, Keene D, Strother D et al (2018) Survival following tumor recurrence in children with medulloblastoma. J Pediatr Hematol Oncol 40(3):e159–e163. https://doi.org/10.1097/MPH.0000000000001095 - DOI - PubMed
    1. Adile AA, Kameda-Smith MM, Bakhshinyan D et al (2020) Salvage therapy for progressive, treatment-refractory or recurrent pediatric medulloblastoma: a systematic review protocol. Syst Rev. 9(1):47. https://doi.org/10.1186/s13643-020-01307-8 - DOI - PubMed - PMC
    1. Massimino M, Gandola L, Spreafico F et al (2009) No salvage using high-dose chemotherapy plus/minus re-irradiation for relapsing previously irradiated medulloblastoma. Int J Radiat Oncol Biol Phys. 73(5):1358–63. https://doi.org/10.1016/j.ijrobp.2008.06.1930 - DOI - PubMed

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