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Pulmonary Function After Treatment for Embryonal Brain Tumors on SJMB03 That Included Craniospinal Irradiation
Daniel M Green1, Thomas E Merchant2, Catherine A Billups3
1Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Craniospinal irradiation (CSI) for embryonal brain tumors (EBT) can lead to long-term pulmonary function deficits in survivors. A significant minority experience decreased lung function, particularly diffusing capacity, months after treatment.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Pulmonology
Background:
- Craniospinal irradiation (CSI) is a standard treatment for embryonal brain tumors (EBT) in children.
- Limited data exist on the long-term pulmonary function effects of CSI in pediatric EBT survivors.
Purpose of the Study:
- To evaluate the impact of CSI on pulmonary function in children and young adults treated for EBT.
- To assess changes in spirometry, lung volumes, and diffusing capacity at 24 and 60 months after treatment completion.
Main Methods:
- Pulmonary function tests (PFTs), including FEV1, FVC, TLC, and DLCO(corr), were performed on EBT patients aged 3-21.
- PFTs were compared immediately after CSI completion to measurements at 24 and 60 months post-treatment.
- Statistical analyses included Wilcoxon signed-rank tests and repeated-measures models.
Main Results:
- A significant minority of survivors showed impaired pulmonary function at 24 and 60 months post-treatment.
- Specifically, DLCO(corr) was significantly decreased at both 24 (P=.028) and 60 months (P=.033) compared to baseline.
- FEV1, FVC, and TLC also showed deficits in a notable percentage of patients.
Conclusions:
- CSI for EBT is associated with significant long-term pulmonary function deficits in a substantial proportion of survivors.
- Continued monitoring of pulmonary function in this cohort is warranted.
- These findings highlight the need for pulmonary surveillance in EBT survivors treated with CSI.
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 [DLCO(corr)]) 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(2) (IQR, 15.7-16.0 g/m(2)). At 24 and 60 months ACT, DLCO(corr) was <75% predicted in 23% (27/118) and 25% (21/84) of patients, FEV1 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(corr) 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(corr) 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.
