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. 2024 May 22;16(11):1955.
doi: 10.3390/cancers16111955.

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

Jonas E Adolph  1 , Gudrun Fleischhack  1 , Sebastian Tschirner  1 , Lydia Rink  1 , Christine Dittes  1 , Ruth Mikasch  1 , Philipp Dammann  2 , Martin Mynarek  3   4 , Denise Obrecht-Sturm  3 , Stefan Rutkowski  3 , Brigitte Bison  5 , Monika Warmuth-Metz  6 , Torsten Pietsch  7 , Stefan M Pfister  8   9   10   11 , Kristian W Pajtler  8   9   10   11 , Till Milde  9   10   11   12   13 , Rolf-Dieter Kortmann  14 , Stefan Dietzsch  14   15 , Beate Timmermann  15 , Stephan Tippelt  1 ; German GPOH HIT-Network
Affiliations

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

Jonas E Adolph et al. Cancers (Basel). .

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.

Keywords: medulloblastoma; radiotherapy; re-irradiation; recurrence; resection.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier plots of the entire cohort, with panel (A) showing PFS and panel (B) showing OS.
Figure 2
Figure 2
Kaplan–Meier plots of all patients with known subgroups, stratified by molecular subgroup. Panel (A) shows PFS; panel (B) shows OS.
Figure 3
Figure 3
Kaplan–Meier plots ((A) for PFS, (B) for OS) for the matched cohort of patients with re-irradiation (RT2) compared to control patients without re-irradiation (No RT); and patient characteristics ((C) as a table comparing ratios and medians, (D) showing love plots of all matched characteristics and overall distance in propensity scores) compared between treated and control subjects. The symbol * designates continuous variables, for which the standardized mean difference is given.
Figure 4
Figure 4
Kaplan–Meier plots for the matched cohort, comparing re-irradiation (RT2) to no radiotherapy at first recurrence (No RT). Panels (A) (PFS) and (B) (OS) show patients with at least subtotal resection at first recurrence, while panels (C) (PFS) and (D) (OS) show patients without resection at first recurrence.
Figure 5
Figure 5
Kaplan–Meier plots comparing survival for patients without previous radiotherapy, stratified by radiotherapy at recurrence. Panel (A) shows PFS; panel (B) shows OS.
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