Intensity-Modulated and 3D-Conformal Radiotherapy for Whole-Ventricular Irradiation as Compared With Conventional Whole-Brain Irradiation in the Management of Localized Central Nervous System Germ Cell Tumors

Chen, Michael; Santos, Adriana da Silva; Sakuraba, R.K.; Lopes, C.P.; Gonçalves, V.D.; Weltman, Eduardo; Ferrigno, Robson; Cruz, José C.

doi:10.1016/j.ijrobp.2009.06.028

Cited by 30 publications

(25 citation statements)

References 41 publications

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“…In the study of Chen et al, IMRT was associated with the lowest irradiated volumes, with reductions of 7.5, 12.2 and 9.0% compared with 3D-CRT. IMRT provided statistically significant reductions of median irradiated volumes at all dose levels [50]. The findings were confirmed by Sakanaka et al [51].…”

Section: Irradiation Techniquesupporting

confidence: 71%

“…Using modern imaging and radiation techniques dose application can now be tailored according to the anatomical requirements. Intensity modulated RT and recently proton therapy permit an optimal coverage while reducing the dose to nontarget brain thereby possibly reducing the risk for a decline in neurocognitive function [50,51,53,54]. It is, however, an open question whether this could translate into a reduction in late sequelae in a predominantly adolescent patient population remains hypothetical [52].…”

Section: Expert Commentarymentioning

confidence: 99%

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Current concepts and future strategies in the management of intracranial germinoma

Kortmann

2014

Expert Review of Anticancer Therapy

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Radiation therapy is the backbone in the management of intracranial germinoma. In localized disease chemotherapy followed by whole brain irradiation is the present standard providing cure rates in excess of 90%. Craniospinal irradiation alone in metastatic disease provides equally excellent outcome. Chemotherapy is able to convert macroscopic to microscopic disease permitting a dose reduction to the tumor site and possibly the ventricular system and is investigated in prospective trials. Chemotherapy alone cannot replace radiotherapy as sole treatment. Whole-ventricular radiotherapy followed by a boost to tumor site without chemotherapy might be feasible. New treatment technologies such as intensity-modulated radiotherapy or proton therapy permit a dose reduction to non-target brain. Data on functional outcome are conflicting and based on small heterogeneous series only mandating prospective investigations.

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Section: Irradiation Techniquesupporting

confidence: 71%

Section: Expert Commentarymentioning

confidence: 99%

Current concepts and future strategies in the management of intracranial germinoma

Kortmann

2014

Expert Review of Anticancer Therapy

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“…However, RT dose to peripheral areas of the body was 1.9 times higher with IMRT than with 3D-CRT. [24] Our institution previously compared DP-IMRT to standard IMRT and found that DP-IMRT decreased mean dose to whole brain, temporal lobes, hippocampi, cochleae, and optic nerves. [25] Whole ventricular PBT is similarly associated with reduced volume of cerebral cortex receiving dose as compared to 3D-CRT and IMRT.…”

Section: Discussionmentioning

confidence: 99%

Reduced-volume radiotherapy for patients with localized intracranial nongerminoma germ cell tumors

Cahlon

Dunkel

et al. 2017

J Neurooncol

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Craniospinal irradiation is standard radiotherapy (RT) for localized intracranial nongerminoma germ cell tumors (NGGCT). Given its toxicity, there is interest in using smaller fields. We examined outcomes of NGGCT patients receiving reduced-volume RT at a single institution. Records of 16 patients who received reduced-volume RT as part of definitive treatment between 1996 and 2016 were reviewed. Median age at presentation was 10.8 years (range, 4.6-41.0 years). Ten patients had pineal tumors and 6 had suprasellar tumors. All received chemotherapy and 9 patients received second-look surgery thereafter. RT volume was tumor-only to a median of 54 Gy (range, 50.4-54 Gy) in 3 patients and whole-ventricle irradiation to a median of 30.6 Gy (range, 30.6-36 Gy) with a boost to 54 Gy in 13 patients. Median follow-up was 4.1 years (range, 1.9-19.3 years). Three patients recurred locally at a median 9.9 months (range, 9.6-10.6 months) after diagnosis, and one of these developed leptomeningeal relapse after 30 months. One patient expired from disease 2.6 years post-diagnosis and another due to stroke 19.3 years post-diagnosis. Fourteen patients are alive with no evidence of disease. Kaplan-Meier estimates of the 4-year overall survival (OS) and failure-free survival (FFS) are 92% (95% confidence interval [CI], 57%-99%) and 81% (95% CI, 53%-94%), respectively. Excellent disease control was observed in these patients with no initial relapses outside of these RT fields. The results of ACNS1123 may better delineate patterns of failure and identify subgroups likely to benefit from this approach.

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“…In this study, a good PTV coverage was achieved in all patients regardless of treatment technique. HT significantly reduced mean dose to the temporal lobes, pituitary gland and chiasm, but not to the brainstem [16]. …”

Section: Discussionmentioning

confidence: 99%

Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity

Mesbah¹,

Matute²,

Usychkin³

et al. 2011

Radiat Oncol

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BackgroundRadiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies.MethodsIn this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume.ResultsThe median age of patients was 5 years. The most common tumor sites were: central nervous system (57%), abdomen (17%) and thorax (6%). The most prevalent histological types were: medulloblastoma (16 patients), neuroblastoma (9 patients) and rhabdomyosarcoma (7 patients). A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72%) were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy). In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6%) of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6%) had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases) were significantly associated with severe toxicity (grade 3 or more), whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity.ConclusionHT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of acute toxicity that we have seen in this highly selected pediatric patient cohort with clinical features of poor prognosis and/or aggressive therapy needed. Despite of a dosimetrical advantage of HT technique, an exhaustive analysis of long-term follow-up data is needed to assess late toxicity, especially in this potentially sensitive to radiation population.

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Intensity-Modulated and 3D-Conformal Radiotherapy for Whole-Ventricular Irradiation as Compared With Conventional Whole-Brain Irradiation in the Management of Localized Central Nervous System Germ Cell Tumors

Cited by 30 publications

References 41 publications

Current concepts and future strategies in the management of intracranial germinoma

Current concepts and future strategies in the management of intracranial germinoma

Reduced-volume radiotherapy for patients with localized intracranial nongerminoma germ cell tumors

Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity

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