Toxicity Reduction after Craniospinal Irradiation via Helical Tomotherapy in Patients with Medulloblastoma: A Unicentric Retrospective Analysis

Abstract

Objectives: Recent trials with craniospinal irradiation (CSI) via helical Tomotherapy (HT) demonstrated encouraging medulloblastoma results. In this study, we assess the toxicity profile of different radiation techniques and estimate survival rates. Materials and Methods: We reviewed the records of 46 patients who underwent irradiation for medulloblastoma between 1999 and 2019 (27 conventional radiotherapy technique (CRT) and 19 HT). Patient, tumor, and treatment characteristics, as well as treatment outcomes—local control rate (LCR), event-free survival (EFS), and overall survival (OS)—were reviewed. Acute and late adverse events (AEs) were evaluated according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results: In total, 43 courses of CSI and three local RT were administered to the 46 patients: 30 were male, the median age was 7 years (range 1–56). A median total RT dose of 55 Gy (range 44–68) and a median CSI dose of 35 Gy (range, 23.4–40) was delivered. During follow-up (median, 99 months), six patients (13%) developed recurrence. The EFS rate after 5 years was 84%. The overall OS rates after 5 and 10 years were 95% and 88%, respectively. There were no treatment-related deaths. Following HT, a trend towards lower grade 2/3 acute upper gastrointestinal (p = 0.07) and subacute CNS (p = 0.05) toxicity rates was detected compared to CRT-group. The risk of late CNS toxicities, mainly grade 2/3, was significantly lower following HT technique (p = 0.003). Conclusion: CSI via HT is an efficacious treatment modality in medulloblastoma patients. In all, we detected a reduced rate of several acute, subacute, and chronic toxicities following HT compared to CRT.

Craniospinal irradiation high dose as independent predictor of permanent alopecia in childhood medulloblastoma survivors: cohort study and literature review

“…Based on our results, exceeded CSI 36 Gy, CSI high dose results the single risk factor for the develop of G1 and G2 permanent alopecia in the whole-scalp as well as in the PCF region, independent of other clinical and therapeutic variables (7,(19)(20)(21). Figure 1 shows the multivariate permanent hair loss etiopathogenesis.…”

The top 100 most cited articles in helical tomotherapy: a scoping review

“…This article, ranked 2nd in terms of total citations with a total of 279, and ranked 1st in terms of CPY with a score of 22.3, had important value in the dosimetry comparative study of prostate cancer. This study suggests that all other approaches yield treatment S2) Type of tumor head and neck cancer 15 (6,11,14,19,20,27,36,39,41,55,64,72,90,91,96) cancers with complex and large targets* 14 (3,9,16,17,35,54,57,62,74,78,88,95,98,99) breast cancer 12 (13, 18, 26, 32, 44, plans of improved quality when compared to 3D-CRT, with HT providing best OAR sparing and VMAT being the most efficient treatment option. This conclusion was supported by other highly cited articles (30)(31)(32).…”

“…Cranial spinal irradiation is mainly indicated for patients diagnosed with CNS tumors, such as medulloblastoma ( 20 , 21 ), germinoma ( 22 ), etc., which is a typical case with complex and large targets and is one of the typical indications for HT. In comparison to other techniques, HT provides superior target coverage, ensuring that the radiation is delivered uniformly and consistently throughout the affected area.…”

“…Study from Turcas et al have reported that the BOT for HT was significantly longer than that of other techniques, with a median BOT of 11 minutes for HT, 5.49 minutes for VMAT, and 1.46 minutes for three dimensional conformal radiation therapy (3D-CRT) (13). While this extended treatment time may be a consideration, the superior clinical outcomes and reduced toxicities associated with HT for craniospinal axis treatment suggest that the benefits outweigh this potential drawback (20)(21)(22).…”

Pulmonary toxicity of craniospinal irradiation using helical tomotherapy

“…Some studies analyzed the pulmonary toxicity in patients who received HT-CSI, one of which reported that none of 18 pediatric patients who received HT-CSI were diagnosed with symptomatic acute radiation pneumonitis 23 . Öztunali et al reported that 2 out of 43 patients aged 7 on average (range 1–56) who received HT-CSI for medulloblastoma were diagnosed with grade 1 pneumonitis and 1 was diagnosed with grade 3 pneumonitis 24 . As these studies showed, all pulmonary toxicity studies in patients who received CSI were mostly conducted on pediatric patients.…”