TY - JOUR
T1 - Pulmonary function after treatment for embryonal brain tumors on SJMB03 that included craniospinal irradiation
AU - Green, Daniel M.
AU - Merchant, Thomas E.
AU - Billups, Catherine A.
AU - Stokes, Dennis C.
AU - Broniscer, Alberto
AU - Bartels, Ute
AU - Chintagumpala, Murali
AU - Hassall, Timothy E.
AU - Gururangan, Sridharan
AU - McCowage, Geoffrey B.
AU - Heath, John A.
AU - Cohn, Richard J.
AU - Fisher, Michael J.
AU - Srinivasan, Ashok
AU - Robinson, Giles W.
AU - Gajjar, Amar
N1 - Funding Information:
Supported by Cancer Center (CORE) Support Grant ( CA 21765 ) from the National Institutes of Health , Musicians against Childhood Cancer (MACC) , the Noyes Foundation , and the American Lebanese Syrian Associated Charities (ALSAC) .
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Purpose The treatment of children with embryonal brain tumors (EBT) includes craniospinal irradiation (CSI). There are limited data regarding the effect of CSI on pulmonary function. Methods Protocol SJMB03 enrolled patients 3 to 21 years of age with EBT. Pulmonary function tests (PFTs) (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC] by spirometry, total lung capacity [TLC] by nitrogen washout or plethysmography, and diffusing capacity of the lung for carbon monoxide corrected for hemoglobin [DLCOcorr]) were obtained. Differences between PFTs obtained immediately after the completion of CSI and 24 or 60 months after the completion of treatment (ACT) were compared using exact Wilcoxon signed-rank tests and repeated-measures models. Results Between June 24, 2003, and March 1, 2010, 303 eligible patients (spine dose: 2345 cGy, 201; >2345 cGy, 102; proton beam, 20) were enrolled, 260 of whom had at least 1 PFT. The median age at diagnosis was 8.9 years (range, 3.1-20.4 years). The median thoracic spinal radiation dose was 23.4 Gy (interquartile range [IQR], 23.4-36.0 Gy). The median cyclophosphamide dose was 16.0 g/m & (IQR, 15.7-16.0 g/m). At 24 and 60 months ACT, DLCO & was <75% predicted in 23% (27/118) and 25% (21/84) of patients, FEV & was <80% predicted in 20% (34/170) and 29% (32/109) of patients, FVC was <80% predicted in 27% (46/172) and 28% (30/108) of patients, and TLC was <75% predicted in 9% (13/138) and 11% (10/92) of patients. DLCO & was significantly decreased 24 months ACT (median difference [MD] in % predicted, 3.00%; P=.028) and 60 months ACT (MD in % predicted, 6.00%; P=.033) compared with the end of radiation therapy. These significant decreases in DLCO & were also observed in repeated-measures models (P=.011 and P=.032 at 24 and 60 months ACT, respectively). Conclusions A significant minority of EBT survivors experience PFT deficits after CSI. Continued monitoring of this cohort is planned.
AB - Purpose The treatment of children with embryonal brain tumors (EBT) includes craniospinal irradiation (CSI). There are limited data regarding the effect of CSI on pulmonary function. Methods Protocol SJMB03 enrolled patients 3 to 21 years of age with EBT. Pulmonary function tests (PFTs) (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC] by spirometry, total lung capacity [TLC] by nitrogen washout or plethysmography, and diffusing capacity of the lung for carbon monoxide corrected for hemoglobin [DLCOcorr]) were obtained. Differences between PFTs obtained immediately after the completion of CSI and 24 or 60 months after the completion of treatment (ACT) were compared using exact Wilcoxon signed-rank tests and repeated-measures models. Results Between June 24, 2003, and March 1, 2010, 303 eligible patients (spine dose: 2345 cGy, 201; >2345 cGy, 102; proton beam, 20) were enrolled, 260 of whom had at least 1 PFT. The median age at diagnosis was 8.9 years (range, 3.1-20.4 years). The median thoracic spinal radiation dose was 23.4 Gy (interquartile range [IQR], 23.4-36.0 Gy). The median cyclophosphamide dose was 16.0 g/m & (IQR, 15.7-16.0 g/m). At 24 and 60 months ACT, DLCO & was <75% predicted in 23% (27/118) and 25% (21/84) of patients, FEV & was <80% predicted in 20% (34/170) and 29% (32/109) of patients, FVC was <80% predicted in 27% (46/172) and 28% (30/108) of patients, and TLC was <75% predicted in 9% (13/138) and 11% (10/92) of patients. DLCO & was significantly decreased 24 months ACT (median difference [MD] in % predicted, 3.00%; P=.028) and 60 months ACT (MD in % predicted, 6.00%; P=.033) compared with the end of radiation therapy. These significant decreases in DLCO & were also observed in repeated-measures models (P=.011 and P=.032 at 24 and 60 months ACT, respectively). Conclusions A significant minority of EBT survivors experience PFT deficits after CSI. Continued monitoring of this cohort is planned.
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U2 - 10.1016/j.ijrobp.2015.05.019
DO - 10.1016/j.ijrobp.2015.05.019
M3 - Article
C2 - 26279023
AN - SCOPUS:84939425568
VL - 93
SP - 47
EP - 53
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
SN - 0360-3016
IS - 1
ER -