Patterns of failure in patients with medulloblastoma

Abstract

Fifty‐two patients with medulloblastoma were seen at Memorial Sloan‐Kettering Cancer Center (MSKCC) between 1959 and 1979. All patients had their primary surgery at other institutions; 27 were referred postoperatively for the initial course of radiation therapy; 24 were referred for treatment of recurrence and 1 patient for adjuvant chemotherapy only. The patients were classified as: (1) Group I: small, localized tumor which was completely excised (14 patients), (2) Group II: large, localized, incompletely excised tumor (10 patients), (3) Group III: tumor spread within the central nervous system (8 patients), (4) Group IV: hematogenous metastases at initial presentation (2 patients). Eighteen patients could not be classified due to insufficient data. Of the 27 patients who received initial radiation treatments at MSKCC, six were of the Groups III and IV and all of these have died. Of the remaining 21 patients with localized disease ten are alive and disease‐free with follow‐up from 20 to 81 months. One patient died free of disease, at 11 months, due to chemotherapy toxicity. Fourteen patients received adjuvant chemotherapy: three received a single drug while 11 received multiple drugs in various combinations of vincristine, cyclophosphamide, methotrexate, lomustin, (CCNU), and prednisone. The extent of disease at the initial treatment was the most important prognostic factor. There were no survivors in the Groups III and IV. The most common site of recurrence was the posterior fossa, 21 of 40 patients, (53%), six patients (15%) had recurrence at the cribriform plate and the adjoining medial frontal lobes, and five (12%) had their first recurrence outside the CNS. None of the patients who received less than 3400 rad to the craniospinal axis or less than 5000 rad to the posterior fossa is alive. The duration of treatment seems to be of less importance for the outcome than the total dose of radiation delivered.

Stray radiation dose and second cancer risk for a pediatric patient receiving craniospinal irradiation with proton beams

“…It is a well established fact that photon craniospinal irradiation provides a substantial benefit to the patient, and it is a key component in the contemporary standard of care, along with surgery and chemotherapy, for medulloblastoma and supratentorial PNET (cf Jereb et al 1982, Timmermann et al 2002, 2006). Miralbell et al (2002) suggested that scanned-beam proton CSI would provide similar tumor control while reducing second cancer risks to approximately 1/15th of those associated with photon therapy.…”

Radiation therapy in the management of childhood brain tumors

“…Several series have emphasized that the posterior fossa is the most critical site of failure with 75% in the Castro-Vita series [21] and 53% in the Jereb series [78]. This author also emphasized the importance of adequate coverage of the anterior cerebral fossa, especially at the level of the cribriform plate, an area frequently shielded inadvertently by the ocular blocks.…”

Histologie des Primärtumors und Metastasenverhalten Implikationen für den Radioonkologen anhand von Beispielen

“…Auch das Boost-Volumen an der hinteren Schädelgrube muß wegen der häufigen leptomeningealen Infiltration um den Hirnstamm, die Nervenaustrittsstellen und Blutgefäße großzügig bemessen sein [24]. Im Falle einer Fernmetastasierung dominieren Knochenherde [9,32]. Strahlendosen unter 50 Gy an der hinteren Schädelgru-be und weniger als 34 Gy am Spinalkanal reichen zu einer lokalen Tumorkontrolle nicht aus [32].…”

“…Im Falle einer Fernmetastasierung dominieren Knochenherde [9,32]. Strahlendosen unter 50 Gy an der hinteren Schädelgru-be und weniger als 34 Gy am Spinalkanal reichen zu einer lokalen Tumorkontrolle nicht aus [32].…”