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Radiation Therapy for Young Children Treated With High-Dose Chemotherapy and Autologous Stem Cell Transplant for
Sarah A Milgrom1, Jane Koo2, Nicholas Foreman3,4,5
1Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
Insights
Peri-transplant radiation therapy (RT) in pediatric brain tumor patients showed encouraging oncologic outcomes, particularly for high-risk cases. However, caution is advised due to observed cases of fatal myelopathy.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-oncology
Background:
- The role of peri-transplant radiation therapy (RT) in children with primary brain tumors remains unclear.
- This study aimed to characterize institutional practice patterns and patient outcomes related to peri-transplant RT.
Purpose of the Study:
- To evaluate the impact of peri-transplant radiation therapy (RT) on outcomes in pediatric patients with primary brain tumors.
- To assess practice patterns and patient outcomes associated with peri-transplant RT in this cohort.
Main Methods:
- Retrospective cohort study of patients treated with high-dose chemotherapy and autologous stem cell transplant for primary brain tumors (2011-2017).
- Assessed local control, progression-free survival, overall survival, and radiation-associated injuries.
- Compared outcomes between patients who received peri-transplant RT (focal or craniospinal irradiation) and those who did not.
Main Results:
- Of 37 patients, 29 (78%) received peri-transplant RT, often for metastatic or incompletely resected disease.
- Two-year local control was 82%, progression-free survival 63%, and overall survival 65%, with no significant difference between RT and non-RT groups.
- Two cases of fatal myelopathy were observed in patients receiving high spinal cord radiation doses.
Conclusions:
- Peri-transplant RT is utilized for high-risk pediatric brain tumors, yielding encouraging oncologic outcomes.
- Despite potential benefits for durable remission, the risk of severe radiation-associated toxicity, such as myelopathy, necessitates cautious application.
Purpose:
: The role of peri-transplant radiation therapy (RT) in children with primary brain tumors is unclear. We characterized our institutional practice patterns and patient outcomes.
Methods And Materials:
The cohort included all patients treated with high-dose chemotherapy and autologous stem cell transplant for primary brain tumors at our institution from 2011 to 2017. Rates of local control, progression-free survival, overall survival, and radiation-associated injury were assessed.
Results:
Of the 37 eligible patients, 29 (78%) received peri-transplant RT. Patients treated with RT were more likely to have metastatic (P = .0121) and incompletely resected (P = .056) disease. Of those treated with RT, 13 (45%) received craniospinal irradiation (CSI) and 16 (55%) received focal RT. The median CSI dose was 23.4 Gy (interquartile range [IQR], 18-36 Gy; boost: median, 54 Gy [IQR, 53.7-55.8 Gy]) and focal RT dose was 50.4 Gy [IQR, 50.4-54.5 Gy]). Compared with the focal RT group, patients treated with CSI were older (P = .0499) and more likely to have metastatic disease (P = .0004). For the complete cohort, 2-year local control was 82% (95% confidence interval [CI], 70%-96%), progression-free survival 63% (95% CI, 49%-81%), and overall survival 65% (95% CI, 51%-82%). These rates did not differ significantly between patients treated with and without peri-transplant RT. Two cases of fatal myelopathy were observed after spinal cord doses within the highest tertile (41.4 cobalt Gy equivalent and 36 Gy).
Conclusions:
Peri-transplant RT was used for high-risk disease. Oncologic outcomes after RT were encouraging. However, 2 cases of grade 5 myelopathy were observed. If used cautiously, RT may contribute to durable remission in patients at high risk of relapse.
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