Radiotherapy for adult medulloblastoma: Long term result from a single institution. A review of prognostic factors and why we do need a multi-institutional cooperative program

Buglione, Michela; Ghirardelli, Paolo; Triggiani, Luca; Pedretti, Sara; Pasinetti, Nadia; Bari, Berardino De; Tonoli, Sandro; Borghetti, Paolo; Spiazzi, L.; Magrini, Stefano Maria

doi:10.1016/j.rpor.2015.03.003

Cited by 16 publications

(8 citation statements)

References 28 publications

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“…One series suggested improved outcomes in adults with desmoplastic histology compared with classic histology, 7 but several others did not. 15,23,24 The genetic underpinnings and behavior of adult MB tumor histologies may be different from those of pediatric tumors, which might explain differences in prognostic status. 15,25 Interpretation of our results in this context, however, may be diminished by the combined coding of classic and NOS histology as one variable in the NCDB.…”

Section: Neurooncologymentioning

confidence: 99%

Adjuvant chemotherapy and overall survival in adult medulloblastoma

Kann¹,

Lester-Coll²,

Park³

et al. 2016

Neuro Oncol

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Medulloblastoma (MB) is the most common brain tumor in children. However, it is relatively rare in adults, with an estimated incidence of 0.6 per million. 1 The standardof-care management for pediatric MB is postoperative radiotherapy (RT) with craniospinal irradiation (CSI) and posterior fossa or resection bed boost followed by adjuvant chemotherapy. 2,3 Adoption of adjuvant chemotherapy in the pediatric setting has been associated with improved disease control and has allowed successful CSI dose deescalation in average-risk patients. [2][3][4][5] Even though chemotherapy is used routinely for pediatric patients, its benefit in adult MB is unclear. Data supporting adjuvant chemotherapy in the adult MB population are scarce. There are no randomized trials investigating the benefit of chemotherapy in adult MB, and evidence is generally limited to small retrospective series reported over several decades with conflicting results. [6][7][8][9] Furthermore, compared with children, adults may suffer less toxicity from CSI and greater morbidity from chemotherapy. This may lead to hesitancy in using postoperative chemotherapy, Adjuvant chemotherapy and overall survival in adult medulloblastoma AbstractBackground. Although chemotherapy is used routinely in pediatric medulloblastoma (MB) patients, its benefit for adult MB is unclear. We evaluated the survival impact of adjuvant chemotherapy in adult MB. Methods. Using the National Cancer Data Base, we identified patients aged 18 years and older who were diagnosed with MB in 2004-2012 and underwent surgical resection and adjuvant craniospinal irradiation (CSI). Patients were divided into those who received adjuvant CSI and chemotherapy (CRT) or CSI alone (RT). Predictors of CRT compared with RT were evaluated with univariable and multivariable logistic regression. Survival analysis was limited to patients receiving CSI doses between 23 and 36 Gy. Overall survival (OS) was evaluated using the Kaplan-Meier estimator, log-rank test, multivariable Cox proportional hazards modeling, and propensity score matching. Results. Of the 751 patients included, 520 (69.2%) received CRT, and 231 (30.8%) received RT. With median followup of 5.0 years, estimated 5-year OS was superior in patients receiving CRT versus RT (86.1% vs 71.6%, P < .0001). On multivariable analysis, after controlling for risk factors, CRT was associated with superior OS compared with RT (HR: 0.53; 95%CI: 0.32-0.88, P = .01). On planned subgroup analyses, the 5 year OS of patients receiving CRT versus RT was improved for M0 patients (P < .0001), for patients receiving 36 Gy CSI (P = .0007), and for M0 patients receiving 36 Gy CSI (P = .0008). Conclusions. This national database analysis demonstrates that combined postoperative chemotherapy and radiotherapy are associated with superior survival for adult MB compared with radiotherapy alone, even for M0 patients who receive high-dose CSI.

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Section: Neurooncologymentioning

confidence: 99%

Adjuvant chemotherapy and overall survival in adult medulloblastoma

Kann¹,

Lester-Coll²,

Park³

et al. 2016

Neuro Oncol

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“…This case lends experiential evidence of re-irradiation of the posterior fossa and brainstem in a pediatric patient with two metachronous intracranial neoplasms. It is key to mention that although there are long-term survivors of glioblastoma 10 (and adult medulloblastoma, 11 which is beyond the scope of this paper) the intent of radiotherapy in this patient was not curative, but aimed to decrease the local tumor burden and to continue a symptomatic relief. It is also important to communicate this to patients in a sensitive and caring manner at the time of consultation, in conjunction with the risks of re-irradiation to critical structures such as the brainstem.…”

Section: Discussion/conclusionmentioning

confidence: 97%

Metachronous medulloblastoma and glioblastoma: Implications for clinical and technical aspects of re-irradiation

Verma

Kulkarni

Bhirud

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Glioblastoma Re-irradiation Brainstem tolerance Toxicity a b s t r a c tA seven-year-old male underwent surgical resection and chemoradiation for average risk medulloblastoma; twelve years later, the presence of a necrotic and infiltrative mass in the same area and invading the brainstem prompted a subtotal resection. Pathology was indicative of glioblastoma. He was then treated with concurrent temozolomide and using biologically effective dose calculations for gross residual tumor tissue in the brainstem as well as brainstem tolerance, a radiotherapy dose of 3750 cGy was chosen, fractionated in twice-daily fractions of 125 cGy each. The gross tumor volume was expanded with a 5 mm margin to the planning target volume, which was also judiciously subtracted from the normal brainstem. He completed his radiotherapy course with subsequent imaging free of residual tumor and continued adjuvant temozolomide and remains under followup surveillance. This case underscores the rarity of metachronous medulloblastoma and glioblastoma, of which only five known cases heretofore have been described. We discuss the technicalities of radiotherapy planning in this patient, including common hurdles for radiation oncologists in similar patients. BackgroundMetachronous brain tumors are defined as the development of at least two histologically distinct primary intracranial neoplasms, not related to local recurrence of the initial tumor. novo tumor. 1 Sometimes, the development of a second primary brain tumor is a result of previous radiation, especially in pediatric patients. 2,3 The presence of certain risk factors, such as familial cancer syndromes, may increase the chance of developing secondary neoplasms after radiotherapy. 4 While many radiation-induced intracranial neoplasms have been reported within fifteen years of radiotherapy, 2,3 http://dx

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“…For example, patients with medulloblastoma show lower age at diagnosis, receives more aggressive surgery, and presents with more hydrocephalus, which increases the risk of neurocognitive damage [29,30]. Furthermore, the RT dose used for CSI in this study was mostly under 20 Gy, which is lower than in other tumor types such as medulloblastoma [31]. The risk and severity of chronic toxicity is increased with younger age and higher RT doses [32].…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes based on radiation therapy fields for bifocal germinoma: Synchronous or disseminated disease?

et al. 2019

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Intracranial germinoma sometimes present as bifocal germinoma, and whether bifocal germinoma should be treated as a synchronous or disseminated disease remains unclear. This study aimed to determine the optimal treatment modality for bifocal germinoma. Patients with bifocal germinoma who received radiotherapy (RT) from March 1990 to August 2017 were included for analysis. A total of 21 patients were included. The median follow-up period was 76.2 months (range, 6.2–305.4 months). There were 17 patients who received cranio-spinal irradiation (CSI) with local RT; 3, whole ventricular RT (WVRT) with local RT; and 1, local RT only. Three recurrences occurred (1 patient each among those who underwent CSI, WVRT, and local RT). Recurrence in the patient who received CSI and who received WVRT occurred in the right thalamus and right frontal convexity, respectively. Meanwhile, the patient who received local RT showed not only a recurred lesion in the hypothalamus, but also cerebrospinal fluid seeding. For this patient, salvage CSI was performed and complete response was achieved after treatment. However, after 9 years and 6 months, he was diagnosed with glioblastoma and expired. As for toxicity, although 17 patients showed decrease in complete blood count levels during treatment, all patients recovered soon after treatment completion. Our findings suggest that bifocal germinoma may be considered as a disseminated disease when considering the patterns of failure according to RT fields. In addition, patients who received CSI showed low acute toxicity rates. However, further studies are necessary to confirm these findings.

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Radiotherapy for adult medulloblastoma: Long term result from a single institution. A review of prognostic factors and why we do need a multi-institutional cooperative program

Abstract: This experience and the analysis of the literature confirm the efficacy of postoperative RT but also the need of large datasets to better define prognostic factors and the possible role of the association of chemotherapy.

Cited by 16 publications

References 28 publications

Adjuvant chemotherapy and overall survival in adult medulloblastoma

Adjuvant chemotherapy and overall survival in adult medulloblastoma

Metachronous medulloblastoma and glioblastoma: Implications for clinical and technical aspects of re-irradiation

Treatment outcomes based on radiation therapy fields for bifocal germinoma: Synchronous or disseminated disease?

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