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Intracranial Orthotopic Allografting of Medulloblastoma Cells in Immunocompromised Mice
Published on: October 3, 2010
Local control in non-metastatic medulloblastoma
Kaitlin M Christopherson1, Julie A Bradley, Ronny L Rotondo
1Department of Radiation Oncology, University of Florida , Gainesville, Florida , USA.
Insights
Long-term medulloblastoma radiotherapy outcomes show chemotherapy and shorter treatment duration improve local control (LC). Modern dose reductions did not compromise disease control, suggesting chemotherapy
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-oncology
Background:
- Review of long-term outcomes for non-metastatic medulloblastoma treated with radiotherapy.
- Analysis of factors influencing local control (LC).
Purpose of the Study:
- To evaluate long-term outcomes and local control (LC) in children with non-metastatic medulloblastoma treated with radiotherapy.
- To identify factors affecting local control (LC) in medulloblastoma patients.
Main Methods:
- Retrospective review of 50 children (M0 medulloblastoma) treated with radiotherapy between 1963-2008.
- Analysis of craniospinal and posterior fossa radiation doses, surgical resection extent, and chemotherapy use.
- Long-term follow-up for overall survival, cancer-specific survival, progression-free survival, and local control (LC).
Main Results:
- 10-year local control (LC) rate was 84%.
- Chemotherapy use was associated with a 10-year LC rate of 100% vs. 76% without chemotherapy (p=0.0454).
- Radiotherapy duration ≤ 45 days was linked to a superior 10-year LC rate of 95% vs. 73% for longer durations (p=0.0419).
Conclusions:
- Reductions in craniospinal dose and boost target volume for toxicity reduction have not compromised disease control.
- Radiotherapy duration, not the interval between surgery and radiotherapy, appears to be a key factor for local control (LC).
- Chemotherapy may play a significant, underappreciated role in improving local control (LC) for medulloblastoma.
Background:
A single-institution review of long-term outcomes and factors affecting local control (LC) following radiotherapy for non-metastatic medulloblastoma.
Material And Methods:
From 1963 to 2008, 50 children (median age, 7.3 years; range 1.2-18.5) with stage M0 medulloblastoma were treated with radiotherapy; half underwent a gross total resection (no visible residual tumor) or near-total resection (< 1.5 cm(3) of gross disease remaining after resection). Median craniospinal dose was 28.8 Gy (range 21.8-38.4 Gy). Median total dose to the posterior fossa was 54.3 Gy (range 42.4-64.8 Gy). Eighteen patients (36%) received chemotherapy as part of multimodality management, including 11 who received concurrent chemotherapy.
Results:
Median follow-up was 15.7 years (range 0.3-44.4 years) for all patients and 26.6 years (range 7.3-44.4 years) for living patients. The 10-year overall survival, cancer-specific survival, and progression-free survival rates were 65%, 65%, and 69%. The 10-year LC rate was 84% and did not significantly change across eras. Four percent of patients experienced local progression five years after treatment. On univariate analysis, chemotherapy and overall duration of radiotherapy ≤ 45 days were associated with improved LC. Patients receiving chemotherapy had a 10-year 100% LC rate versus 76% in patients not receiving chemotherapy (p = 0.0454). When overall radiotherapy treatment lasted ≤ 45 days, patients experienced a superior 95% 10-year LC rate (vs. 73% in patients treated > 45 days; p = 0.0419). Three patients (6%) died from treatment complications, including radionecrosis/cerebellar degeneration, severe cerebral edema leading to herniation, and secondary malignancy.
Conclusions:
While we cannot draw definitive conclusions given the retrospective nature of our study, our long-term data suggest that reductions in craniospinal dose and boost target volume to reduce toxicity have not compromised disease control in the modern era. Our data also support analyses that implicate duration of radiotherapy, rather than interval between surgery and radiotherapy, as a factor in LC. Chemotherapy in multimodality management of medulloblastoma may have an underappreciated role in improving LC rates.
