No abstract

The overall risk of second primary malignancies is increased for thyroid cancer survivors and varies by radioisotope therapy, latency, and age at diagnosis.

PURPOSE Efficacy and acute toxicity of proton craniospinal irradiation (p-CSI) were compared with conventional photon CSI (x-CSI) for adults with medulloblastoma. METHODS AND MATERIALS Forty adult medulloblastoma patients treated with x-CSI (n=21) or p-CSI (n=19) at XXXXX from 2003–2011 were retrospectively reviewed. Median CSI and total doses were 30.6 and 54 Gy, respectively. The median follow-up was 57 months (range 4–103) for x-CSI patients and 26 months (range 11–63) for p-CSI. RESULTS p-CSI patients lost less weight than x-CSI patients (1.2%, versus 5.8%; p=0.004), and less p-CSI patients had greater than 5% weight loss compared to x-CSI (16% versus 64%; p=0.004). p-CSI patients experienced less grade 2 nausea and vomiting compared to x-CSI (26% versus 71%; p=0.004). Patients treated with x-CSI were more likely to have medical management of esophagitis than p-CSI patients (57% vs 5%, p=<0.001). p-CSI patients had a smaller reduction in peripheral white blood cells (WBC), hemoglobin and platelets compared to x-CSI (WBC 46% versus 55%, p=0.04; hemoglobin 88% versus 97%, p=0.009; platelets 48% versus 65%, p=0.05). Mean vertebral doses were significantly associated with reductions in blood counts. CONCLUSIONS This report is the first analysis of clinical outcomes for adult medulloblastoma patients treated with p-CSI. Patients treated with p-CSI experienced less treatment-related morbidity including less acute gastrointestinal and hematologic toxicities.

The case records of 235 patients who were treated for differentiated thyroid cancer between 1949 and 1981 were reviewed. Forty-two (18%) had distant metastatic spread outside the neck and received radioiodine (131I) therapy. In cases where the distant spread was confined to the lungs, 54% of patients were alive, free of disease, 10 years after 131I treatment was started. By contrast, no patient with skeletal involvement has survived for 10 years and only one for five years after treatment. A variety of cytotoxic drugs has been tried on an ad hoc basis with no notable success. One patient developed preleukaemia three months after completion of 131I treatment, but no other serious side effects were observed. Factors that influence the behaviour of metastatic thyroid carcinoma are discussed and a possible revised approach to 131I therapy is suggested in the light of these findings.