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Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review
Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
Johns Hopkins Sch Med, Dept Radiat & Mol Radiat Sci, Sidney Kimmel Comprehens Canc Ctr, 401 N Broadway,Suite 1440, Baltimore, MD 21231 USA..
Ctr Infantil Boldrini, Dept Radiat Oncol, Sao Paulo, Brazil..
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2017 (English)In: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 99, no 3, p. 634-641Article in journal (Refereed) Published
Abstract [en]

Purpose: Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients.

Methods and Materials: The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed.

Results: Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n = 20; 30%), ependymoma (n = 19; 28%), germ cell tumor (n = 8; 12%), high-grade glioma (n = 9; 13%), low-grade glioma (n = 5; 7%), and other (n = 6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n = 46), 3-dimensional conformal RT (n = 9), stereotactic radiosurgery (n = 4; 1213 Gy x 1 or 5 Gy x 5), protons (n = 4), combined modality (n = 3), 2-dimensional RT (n = 1), and brachytherapy (n = 1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively.

Conclusions: CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2017. Vol. 99, no 3, p. 634-641
National Category
Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-336424DOI: 10.1016/j.ijrobp.2017.07.026ISI: 000411225300024OAI: oai:DiVA.org:uu-336424DiVA, id: diva2:1167163
Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2017-12-18Bibliographically approved

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Nilsson, Kristina

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