Medulloblastoma in childhood: Impact of radiation technique upon the outcome of treatment

Chojnacka, Marzanna; Skowrońska‐Gardas, Anna

doi:10.1002/pbc.10401

Cited by 21 publications

(19 citation statements)

References 43 publications

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“…It is reasonable to assume that the olfactory nerve will be contained within a CTV that includes the cribiform plate, and this has already been discussed. 4,[19][20][21] We know that the optic nerves are surrounded by CSF to the back of the globe and that some RT planning techniques (tomotherapy) underdose this area unless it is specifically contoured as part of the CTV. 51 Neither our work nor the literature investigates whether there are meningeal reflections and CSF through the middle cranial fossa foramen, superior orbital fissure, ovale, rotundum and spinosum and this would be an interesting topic for further research.…”

Section: Discussionmentioning

confidence: 99%

“…Studies report the risk of cribiform plate recurrence in patients undergoing CSI in the era before this was considered to be part of the target volume, or when it was underdosed owing to either inadequate technique or deliberate shielding of the eyes. 4,[19][20][21] The same technical errors also resulted in recurrences inferiorly in the frontal and temporal lobes, 21 and there is now a general consensus that these structures should be included in the target volume however RT is planned and delivered.…”

Section: Clinical Settingmentioning

confidence: 99%

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Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Noble¹,

Scoffings²,

Ajithkumar³

et al. 2016

BJR

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Objective: There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. Methods: 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42,45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. Results: IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was 20.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Conclusion: Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Settingmentioning

confidence: 99%

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Noble¹,

Scoffings²,

Ajithkumar³

et al. 2016

BJR

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“…High-energy electrons for spine irradiation have been used since 1986 and this 2D technique and treatment results in 158 children with medulloblastoma were published previously. 11 In the next report we presented the outcome and patterns of failure for 95 patients with medulloblastoma treated with 3D-conformal radiotherapy. 12 New equipment installed in our department (accelerators with CBCT and TPS with forward IMRT planning) together with an increasing number of young children treated under anaesthesia led us to reconsider our technique of craniospinal irradiation.…”

Section: Introductionmentioning

confidence: 97%

Craniospinal radiotherapy in children: Electron- or photon-based technique of spinal irradiation

Chojnacka

Skowrońska‐Gardas

Morawska-Kaczyńska

et al. 2010

Reports of Practical Oncology & Radiotherapy

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“…[4][5][6] Long-term survivors experience a spectrum of radiation-related treatment effects including hearing loss, 7 endocrine deficiencies, 8 somatic effects, 9 cognitive decline, 10 cerebrovascular damage 11,12 and secondary malignancies. 13 Measures have been taken to lessen the effects of radiation therapy for patients who have favorable outcomes including those with average-risk MB 14 defined as no evidence of neuraxis dissemination, a minimal amount of residual tumor and no evidence of brainstem invasion or transtentorial extension from the primary site.…”

Section: Introductionmentioning

confidence: 99%

Multi-Institution Prospective Trial of Reduced-Dose Craniospinal Irradiation (23.4 Gy) Followed by Conformal Posterior Fossa (36 Gy) and Primary Site Irradiation (55.8 Gy) and Dose-Intensive Chemotherapy for Average-Risk Medulloblastoma

Merchant¹,

Kun²,

Krasin³

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

153

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Purpose/Objective-Limiting neurocognitive sequelae of radiation therapy (RT) has been an objective in the treatment of medulloblastoma (MB). Conformal RT to less than the entire posterior fossa (PF) after craniospinal irradiation (CSI) may reduce neurocognitive sequelae and requires evaluation. October 1996 and August 2003, 86 patients, 3-21 years of age, with newly diagnosed, average-risk MB were treated on a prospective, IRB-approved, multi-institution trial of risk-adapted RT and dose-intensive chemotherapy. RT began within 28 days of definitive surgery and consisted of CSI (23.4 Gy), conformal PF RT (36.0 Gy) and primary site RT (55.8 Gy). The planning target volume for the primary site included the post-operative tumor bed surrounded by an anatomically confined margin of 2 cm which was then expanded with a geometric margin of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Materials/Methods-Between CONFLICT OF INTEREST NOTIFICATION:There are no conflicts of interest with the authors or materials in this manuscript. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript 0.3-0.5 cm. Chemotherapy was initiated 6 weeks after RT and included 4 cycles of high-dose cyclophosphamide, cisplatin and vincristine.Results-With a median follow-up of 61.2 months (5.2-115.0 months), the estimated 5-year eventfree survival and cumulative incidence of PF failure were 83.0% ± 5.3% and 4.9% ± 2.4% (±SE), respectively. Targeting guidelines used in this study resulted in a mean reduction of 13% in the volume of the PF receiving doses above 55Gy compared to conventionally planned RT. Reductions in dose to the temporal lobes, cochleae and hypothalamus were statistically significant.Conclusions-This prospective trial demonstrates that irradiation of less than the entire PF after 23.4 Gy CSI for average-risk MB results in disease control comparable to treatment of the entire PF.

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Medulloblastoma in childhood: Impact of radiation technique upon the outcome of treatment

Cited by 21 publications

References 43 publications

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Craniospinal radiotherapy in children: Electron- or photon-based technique of spinal irradiation

Multi-Institution Prospective Trial of Reduced-Dose Craniospinal Irradiation (23.4 Gy) Followed by Conformal Posterior Fossa (36 Gy) and Primary Site Irradiation (55.8 Gy) and Dose-Intensive Chemotherapy for Average-Risk Medulloblastoma

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