Impact of targeting deviations on outcome in medulloblastoma: study of the French society of pediatric oncology (SFOP)11Participating institutions including more than one patient: Centre Paul Papin—Angers (M. Mege); Bruxelles (C. De Vriendt); Centre Claudius Regaud—Toulouse (F. Soum); Hôpital Charles Nicolle—Rouen (S. Seng); Institut Jean Godinot—Reims (X. Panis); Hôpital Bellevue—Saint-Etienne (T. Schmitt).

Carrié, C.; Hoffstetter, S.; Gómez, F.; Moncho, V; Doz, François; Alapetite, Claire; Murraciole, X.; Maire, Jean Philippe; Ben-Hassel, M.; Chapet, S.; Quétin, Philippe; Kolodié, H; Lagrange, Jean‐Léon; Cuillere, J.C.; Habrand, Jean‐Louis

doi:10.1016/s0360-3016(99)00200-x

Cited by 141 publications

(9 citation statements)

References 10 publications

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“…Carrie et al (1999) reported the impact of targeting deviations on outcome in the French Society of Pediatric Oncology (SFOP) experience with both standard risk and high-risk MB. The most frequent major deviation identified in the 169 patients evaluable for correlation between targeting deviation and the site of relapse was the cribriform plate and the lower part of the temporal lobe.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment set up for this disease is challenging as a 5-mm shift in patient alignment can bring the radiation field edge into the intended target of both the central nervous system and the spine. Carrie et al (1999) and Miralbell et al (2006) have demonstrated that often multiple deviations must be present in the same patient in order to influence outcome. Deviations on our study were assigned at several anatomical locations, perhaps making it more difficult to demonstrate that individual deviations directly affect outcome.…”

Section: Discussionmentioning

confidence: 99%

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Radiation therapy quality in CCG/POG intergroup 9961: implications for craniospinal irradiation and the posterior fossa boost in future medulloblastoma trials

Donahue¹,

Marymont²,

Kessel³

et al. 2012

Front. Oncol.

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Purpose: Associations of radiation therapy (RT) deviations and outcomes in medulloblastoma have not been defined well, particularly in the era of reduced-dose craniospinal irradiation and chemotherapy. The aim of this study is to evaluate the quality of RT on Children’s Cancer Group/Pediatric Oncology Group 9961 and analyze associations of RT deviations with outcome. Materials and Methods: Major volume deviations were assessed based on the distance from specified anatomical region to field edge. We investigated associations of RT deviations with progression-free survival (PFS), overall survival (OS), and explored associations with demographics and clinical variables. Results: Of the 308 patients who were evaluable for volume deviations, 101 patients (33%) did not have any. Of the remaining 207 patients, 50% had only minor deviations, 29% had only major deviations, and 21% had both minor and major deviations. Of the patients with major deviations, 73% had a single major deviation. The most common major deviation was in the cribriform plate region, followed by the posterior fossa (PF); PF deviations resulted from treating less than whole PF. There were no significant differences in PFS or OS between patients with deviations and those without. There was no evidence of associations of deviations with patient age. Conclusions: Approximately one-third of patients had major volume deviations. There was no evidence of a significant association between these and outcome. This lack of correlation likely reflects the current high quality of RT delivered in Children’s Oncology Group institutions, our strict definition of volume deviations, and the relatively few instances of multiple major deviations in individual patients. In is noteworthy that the types of PF volume deviations observed in this study were not adversely associated with outcome. As we move forward, quality assurance will continue to play an important role to ensure that deviations on study do not influence study outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiation therapy quality in CCG/POG intergroup 9961: implications for craniospinal irradiation and the posterior fossa boost in future medulloblastoma trials

Donahue¹,

Marymont²,

Kessel³

et al. 2012

Front. Oncol.

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“…Irradiation techniques and delivery modalities for CSI have also evolved. Multiple studies have demonstrated the critical importance of ensuring adequate coverage of the entire target volume, encompassing the meninges covering the brain and spinal cord, including extensions along the nerve roots, with more frequent relapses and inferior survival being observed in patients treated with CSI with targeting deviations [58][59][60]. Thus, current standard techniques employ computed tomography (CT)-based target delineation, often with the supplemental use of magnetic resonance imaging (MRI) through image registration techniques, and image-guided RT, usually in the form of planar X-rays or cone-beam CT, to ensure interfraction reproducibility.…”

Section: Advances In Radiotherapy Techniquesmentioning

confidence: 99%

Preclinical Models of Craniospinal Irradiation for Medulloblastoma

Stripay

Merchant

Roussel

et al. 2020

Cancers

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Medulloblastoma is an embryonal tumor that shows a predilection for distant metastatic spread and leptomeningeal seeding. For most patients, optimal management of medulloblastoma includes maximum safe resection followed by adjuvant craniospinal irradiation (CSI) and chemotherapy. Although CSI is crucial in treating medulloblastoma, the realization that medulloblastoma is a heterogeneous disease comprising four distinct molecular subgroups (wingless [WNT], sonic hedgehog [SHH], Group 3 [G3], and Group 4 [G4]) with distinct clinical characteristics and prognoses has refocused efforts to better define the optimal role of CSI within and across disease subgroups. The ability to deliver clinically relevant CSI to preclinical models of medulloblastoma offers the potential to study radiation dose and volume effects on tumor control and toxicity in these subgroups and to identify subgroup-specific combination adjuvant therapies. Recent efforts have employed commercial image-guided small animal irradiation systems as well as custom approaches to deliver accurate and reproducible fractionated CSI in various preclinical models of medulloblastoma. Here, we provide an overview of the current clinical indications for, and technical aspects of, irradiation of pediatric medulloblastoma. We then review the current literature on preclinical modeling of and treatment interventions for medulloblastoma and conclude with a summary of challenges in the field of preclinical modeling of CSI for the treatment of leptomeningeal seeding tumors.Cancers 2020, 12, 133 2 of 16 for, medulloblastoma. The review concludes with a summary of outstanding questions in the field of preclinical modeling of RT for pediatric brain tumors and a consideration of future directions for treating leptomeningeal seeding tumors with these approaches. Clinical Management of Medulloblastoma: The Evolving Role of Radiation Therapy BackgroundLike many embryonal tumors, medulloblastoma shows a predilection for distant metastatic spread and leptomeningeal seeding, with subarachnoid dissemination present in approximately 20% to 35% of cases at diagnosis and in most cases at relapse [7,8]. CSI targeting the entire neuraxis has been a standard-of-care therapy for most patients. As cure became a reality, however, long-term survivors were noted to suffer from significant radiation-associated late effects, including neurocognitive and neuroendocrine deficits, bone and soft tissue hypoplasia, vascular insults, and subsequent malignant neoplasms. Thus, efforts have been directed toward maintaining or improving overall survival rates while minimizing treatment-related toxicity. These efforts have primarily focused on modifications to RT approaches that can be broadly grouped as follows: investigations of the effects of adding concurrent and/or adjuvant chemotherapy regimens [9,10]; investigations of the effects of delaying or omitting RT for very young children [11][12][13][14]; investigations of the effects of reductions in the RT dose and field size [15,16]; and, over the past...

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“…The literature reports a relationship between inadequate technique and patterns of relapse [2], [3], [4]. Although most of these tumours arise in the posterior cranial fossa, they are known to spread to leptomeningeal surfaces throughout the craniospinal axis (CSA) and the evolution of radiotherapy techniques used for medulloblastoma reflects this biology.…”

Section: Introductionmentioning

confidence: 99%

“…Studies report a high risk of medulloblastoma recurrence in the cribriform plate and inferior frontal and temporal lobes when they were not included in the target volume or when they were missed due to shielding of the eyes [4], [14], [15], [16]. These structures are therefore now included routinely in the clinical target volume (CTV).…”

Section: Introductionmentioning

confidence: 99%

Highly Conformal Craniospinal Radiotherapy Techniques Can Underdose the Cranial Clinical Target Volume if Leptomeningeal Extension through Skull Base Exit Foramina is not Contoured

Noble

Ajithkumar

Lambert³

et al. 2017

Clinical Oncology

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AimsCraniospinal irradiation (CSI) remains a crucial treatment for patients with medulloblastoma. There is uncertainty about how to manage meningeal surfaces and cerebrospinal fluid (CSF) that follows cranial nerves exiting skull base foramina. The purpose of this study was to assess plan quality and dose coverage of posterior cranial fossa foramina with both photon and proton therapy.Materials and methodsWe analysed the radiotherapy plans of seven patients treated with CSI for medulloblastoma and primitive neuro-ectodermal tumours and three with ependymoma (total n = 10). Four had been treated with a field-based technique and six with TomoTherapy™. The internal acoustic meatus (IAM), jugular foramen (JF) and hypoglossal canal (HC) were contoured and added to the original treatment clinical target volume (Plan_CTV) to create a Test_CTV. This was grown to a test planning target volume (Test_PTV) for comparison with a Plan_PTV. Using Plan_CTV and Plan_PTV, proton plans were generated for all 10 cases. The following dosimetry data were recorded: conformity (dice similarity coefficient) and homogeneity index (D2 − D98/D50) as well as median and maximum dose (D2%) to Plan_PTV, V95% and minimum dose (D99.9%) to Plan_CTV and Test_CTV and Plan_PTV and Test_PTV, V95% and minimum dose (D98%) to foramina PTVs.ResultsProton and TomoTherapy™ plans were more conformal (0.87, 0.86) and homogeneous (0.07, 0.04) than field-photon plans (0.79, 0.17). However, field-photon plans covered the IAM, JF and HC PTVs better than proton plans (P = 0.002, 0.004, 0.003, respectively). TomoTherapy™ plans covered the IAM and JF better than proton plans (P = 0.000, 0.002, respectively) but the result for the HC was not significant. Adding foramen CTVs/PTVs made no difference for field plans. The mean Dmin dropped 3.4% from Plan_PTV to Test_PTV for TomoTherapy™ (not significant) and 14.8% for protons (P = 0.001).ConclusionsHighly conformal CSI techniques may underdose meninges and CSF in the dural reflections of posterior fossa cranial nerves unless these structures are specifically included in the CTV.

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Cited by 141 publications

References 10 publications

Radiation therapy quality in CCG/POG intergroup 9961: implications for craniospinal irradiation and the posterior fossa boost in future medulloblastoma trials

Radiation therapy quality in CCG/POG intergroup 9961: implications for craniospinal irradiation and the posterior fossa boost in future medulloblastoma trials

Preclinical Models of Craniospinal Irradiation for Medulloblastoma

Highly Conformal Craniospinal Radiotherapy Techniques Can Underdose the Cranial Clinical Target Volume if Leptomeningeal Extension through Skull Base Exit Foramina is not Contoured

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