Local control after craniospinal irradiation, intensity-modulated radiotherapy boost, and chemotherapy in childhood medulloblastoma

Arnold C. Paulino, Ali Mazloom, Bin S. Teh, Michael South, M. Fatih Okcu, Jack Su, E. Brian Butler, Murali Chintagumpala

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Background: The current study was conducted to determine whether the use of cochlear-sparing intensity-modulated radiotherapy (IMRT) boost results in excess local failures in children with medulloblastoma. Methods: Fifty children with a median age of 7.8 years underwent resection, craniospinal irradiation (CSI), IMRT posterior fossa (PF) and/or tumor bed (TB) boost, and cisplatin-based chemotherapy for medulloblastoma. For standard-risk patients, the CSI dose was 18 to 23.4 grays (Gy) and was followed either by an IMRT PF boost to 36 Gy and a TB boost of 54 to 55.8 Gy (n = 29) or by an IMRT TB boost to 55.8 Gy (n = 4). For high-risk patients, the CSI dose was 36 to 39.6 Gy followed by an IMRT PF boost to 54 to 55.8 Gy (n = 8), an IMRT PF boost to 45 Gy and a TB boost to 55.8 Gy (n = 2), or an IMRT TB boost to 55.8 Gy (n = 7). For the TB boost, a 2-cm margin around the surgical bed was treated in most patients. Results: The 5-year overall and progression-free survival rates (± standard deviation) were 72% ± 6.6% and 68.3% ± 6.8%, respectively, for all patients; 77.8% ± 7.4% and 75.1% ± 7.6%, respectively, for standard-risk patients; and 60.8% ± 12.8% and 55.4% ± 12.8%, respectively, for high-risk patients. The 5-year PF control rate was 90.5% ± 4.6%. TB failures occurred in 3 patients (including 2 patients who had distant failure), whereas an isolated non-TB PF failure occurred in 1 patient. Conclusions: The use of IMRT was associated with excellent local control and did not result in excess PF failures outside of the TB.

Original languageEnglish (US)
Pages (from-to)635-641
Number of pages7
JournalCancer
Volume117
Issue number3
DOIs
StatePublished - Feb 1 2011

Keywords

  • intensity-modulated radiotherapy
  • local control
  • medulloblastoma
  • pediatric brain tumor
  • radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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