Patterns of failure in children with medulloblastoma treated with 3D conformal radiotherapy

Skowrońska‐Gardas, Anna; Chojnacka, Marzanna; Morawska-Kaczyńska, M.; Perek, Danuta; Perek-Polnik, Marta

doi:10.1016/j.radonc.2007.05.018

Cited by 25 publications

(17 citation statements)

References 30 publications

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“…Their typical pattern of spread is to meningeal surfaces, frequently locoregionally in the posterior fossa. 6,7 The RT approach reflects this biology and current "gold standard" involves irradiation of the entire craniospinal axis (CSI) with a boost to the posterior fossa and tumour bed. Ependymomas are rare tumours arising from glial cells (primary gliomas).…”

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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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: 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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“…11,12 Our new photon-based technique is a two-isocentre treatment technique which could be applied for both the supine and prone position. We performed two methods of planning: conformal 3D (for 7 patients) and forward planned segmented fields (for 4 patients).…”

Section: Methodsmentioning

confidence: 99%

“…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. Therefore we propose a new, photon-based technique with characteristic features: two isocentres, intrafraction moving beam junction, and oblique beams in the thyroid region between lateral cranial and posterior spinal beams.…”

Section: Introductionmentioning

confidence: 99%

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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“…However, these refinements in irradiation technique have not consistently led to improvements in outcome [7,37,57,58]. In patients with tumors such as astrocytomas, in whom the tumor volume is irradiated, more than 90% of recurrences occur in the high-dose region of irradiation [51].…”

Section: Adjuvant Treatmentmentioning

confidence: 99%

Different Treatment Strategies for Pediatric Brain Tumors

Fiorillo

2008

CPR

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Malignant brain tumors are characterized by high local aggressiveness and tendency to metastasize within the central nervous system (CNS), and rarely outside it. Surgical approach represented and still represents the mainstay of treatment strategies. However, in the majority of cases, gross total resection is recommended to achieve long event-free survival and eventually the cure. In recent years neoadjuvant chemotherapy and adjuvant post-surgical radiotherapy and chemotherapy have gained relevance in facilitating complete surgical removal and in achieving and consolidating complete remission of such tumors. Post-surgical radiation therapy still represents the basic adjuvant treatment for children over three years with standard risk, non metastatic medulloblastoma. This approach is also considered a very important tool for children affected by ependymoma. However, associated chemotherapy is also needed when reduced doses of radiation therapy are administered, in cases of tumors characterized by a more aggressive biologic behaviour, such as high grade gliomas, and metastatic tumors of any origins. The majority of CNS tumors are of neuroepithelial origin and as such responsive to many antineoplastic drugs, like alkylating agents, antimetabolites, and alkaloids. However, in order to reach tumor cells inside the CNS these drugs have to overcome the blood brain barrier. A number of interesting tools able to disrupt or bypass the barrier, such as ionizing radiations, osmotic procedures or the liposomal technology applied to antiblastic drugs, exists. Starting from a dose of radiation of 30 Gy the permeability of an irradiated area is significantly increased compared to that of the unirradiated surrounding cerebral tissue. Many present treatment regimens include concurrent radiotherapy and chemotherapy in the post-surgical phase, and encouraging results have been reported. In the future better results will certainly come from modern technologies applied to radiation therapy, such as tomo-therapy, and from discovery of new drugs or alternative methods of administration of conventional ones.

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Patterns of failure in children with medulloblastoma treated with 3D conformal radiotherapy

Cited by 25 publications

References 30 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

Different Treatment Strategies for Pediatric Brain Tumors

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