Supratentorial recurrences in medulloblastoma

Jereb, Berta; Sundaresan, Narayan; Horten, Bruce; Reid, Ann; Galicich, Joseph H.

doi:10.1002/1097-0142(19810215)47:4<806::aid-cncr2820470429>3.0.co;2-p

Cited by 54 publications

(18 citation statements)

References 22 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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“…Supratentorial lesions accounted for only 6% of recurrences. Recent reports, however, have indicated that supratentorial recurrences may be more common than previously assumed [21]. Two common patterns of treatment failure are illustrated in the cases reported in this study.…”

Section: Discussionmentioning

confidence: 42%

“…One patient had local recurrence in the posterior fossa, while the other patient had recurrence in the frontal lobe adjacent to the cribriform plate. Frontal lobe recurrence has also been reported in previous studies [21] and the importance of employing radiation fields which include the cribriform plate with generous margin has been stressed [21].…”

Section: Discussionmentioning

confidence: 71%

Intra-arterial BCNU in the treatment of recurrent medulloblastoma

Watne

Hager

Hirschberg³

1990

J Neuro-Oncol

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Two patients with recurrent medulloblastomas were treated with combined oral and intravenous chemotherapy followed by intra-arterial BCNU. The 7 days course of oral and intra-venous chemotherapy consisted of CCNU and Procarbazin orally and Vincristine intravenously (PCV), repeated after 6 weeks. Intra-arterial chemotherapy consisted of 4 cycles of BCNU. Both patients responded well to treatment, evaluated by CT scans. One of the patients died of a new local recurrence 6 months after initiation of chemotherapy, whereas the other patient remains well, without CT evidence of tumour 36 months after the start of the treatment. No serious adverse side-effects related to the treatment were seen.

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“…Isolated sub-frontal relapse may occasionally be seen following CS-RT, and this may be attributed to an inadequate radiation dose in the cribriform plate region [7]. Certainly when lateral shaped fields are used, the eye block component may shield this region.…”

Section: The Cribriform Platementioning

confidence: 99%

The radiation treatment of medulloblastoma

Jenkin

1996

J Neuro-Oncol

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Following the introduction of CS-RT the survival rate for this malignant tumour rose from zero to approximately 50%. It appears that the major advances over the last twenty years associated with the introduction of CT/MRI, adequate staging, total resection, adjuvant therapy and improved radiation technique has only added 10-20% to the survival rate making it extremely difficult to evaluate the impact of these advances. While radiation treatment is currently omitted or delayed under the age of 36 months, due to enhanced neurocognitive toxicity, and replaced by maintained systemic therapy, the early encouraging results must stand the test of time in order to become standard practice. The treatment of a child with medulloblastoma with radiation treatment remains the corner stone of treatment while additional novel therapies are being developed.

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Supratentorial recurrences in medulloblastoma

Cited by 54 publications

References 22 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

Intra-arterial BCNU in the treatment of recurrent medulloblastoma

The radiation treatment of medulloblastoma

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