Top

Child's Nervous System

Published in:

Open Access 01-02-2019 | Original Paper

Radiosurgery or hypofractionated stereotactic radiotherapy after craniospinal irradiation in children and adults with medulloblastoma and ependymoma

Authors: Aleksandra Napieralska, Iwona Brąclik, Michał Radwan, Marek Mandera, Sławomir Blamek

Published in: Child's Nervous System | Issue 2/2019

Abstract

Purpose

To assess the results and tolerance of radiosurgery/hypofractionated stereotactic radiotherapy performed after craniospinal irradiation for recurrent tumor.

Methods

Fourteen patients aged 3–46 years, diagnosed with medulloblastoma (10), anaplastic ependymoma (3), and primitive neuroectodermal tumor (1). All patients had craniospinal irradiation (CSI) with the total dose of 30.6–36 Gy and boost to 53.9–60 Gy either during primary or during second-line treatment. Twelve patients were irradiated with a single dose of 6–15 Gy (median 14.5 Gy). One received three fractions of 5 Gy and one six fractions of 5 Gy. In statistical analysis, the Kaplan-Meier method and log-rank test were used. The overall survival was calculated from the date of the end of stereotactic radiosurgery to the date of death or last contact.

Results

Recurrences were diagnosed after the median time of 16 months after the end of primary treatment. Eleven patients died during the follow-up. The follow-up for the 3 patients still alive was 6.7, 40.5, and 41.4 months, respectively. One- and 2-year overall survival (OS) was 70% and 39%. Patients who had ECOG performance status of 0 at the time of diagnosis of the disease trended to have better 2-year OS compared to those evaluated as ECOG 1 (p = 0.057). Treatment results were evaluable in 12 patients. Local control (stabilization or regression of the lesion) was achieved in 9 (75%). Overall disease progression was 67%. No patient developed radiation-induced necrosis. The treatment was well tolerated and no serious adverse effects were observed. Eleven patients were given steroids as a prevention of brain edema and four of them needed continuation of this treatment afterwards. In 7 patients, symptoms of brain edema were observed during the first weeks after reirradiation.

Conclusions

Stereotactic radiosurgery or hypofractionated stereotactic radiotherapy is an effective treatment method of the local recurrence after CSI and can be performed safely in heavily pre-treated patients.

Lannering B, Rutkowski S, Doz F, Pizer B, Gustafsson G, Navajas A, Massimino M, Reddingius R, Benesch M, Carrie C, Taylor R, Gandola L, Björk-Eriksson T, Giralt J, Oldenburger F, Pietsch T, Figarella-Branger D, Robson K, Forni M, Clifford SC, Warmuth-Metz M, von Hoff K, Faldum A, Mosseri V, Kortmann R (2012) Hyperfractionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma: results from the randomized multicenter HIT-SIOP PNET 4 trial. J Clin Oncol 30:3187–3193. https://doi.org/10.1200/JCO.2011.39.8719 CrossRefPubMed

Call JA, Naik M, Rodriguez FJ, Giannini C, Wu W, Buckner JC, Parney IF, Laack NN (2014) Long-term outcomes and role of chemotherapy in adults with newly diagnosed medulloblastoma. Am J Clin Oncol 37:1–7. https://doi.org/10.1097/COC.0b013e31826b9cf0 CrossRefPubMedPubMedCentral

von Bueren AO, von Hoff K, Pietsch T, Gerber NU, Warmuth-Metz M, Deinlein F, Zwiener I, Faldum A, Fleischhack G, Benesch M, Krauss J, Kuehl J, Kortmann RD, Rutkowski S (2011) Treatment of young children with localized medulloblastoma by chemotherapy alone: results of the prospective, multicenter trial HIT 2000 confirming the prognostic impact of histology. Neuro-Oncology 13:669–679. https://doi.org/10.1093/neuonc/nor025 CrossRef

Packer RJ, Zhou T, Holmes E, Vezina G, Gajjar A (2013) Survival and secondary tumors in children with medulloblastoma receiving radiotherapy and adjuvant chemotherapy: results of Children’s Oncology Group trial A9961. Neuro-Oncology 15:97–103. https://doi.org/10.1093/neuonc/nos267 CrossRefPubMed

Atalar B, Ozsahin M, Call J, Napieralska A, Kamer S, Villa S, Erpolat P, Negretti L, Lassen-Ramshad Y, Onal C, Akyurek S, Ugurluer G, Baumert BG, Servagi-Vernat S, Miller RC, Ozyar E, Sio TT (2018) Treatment outcome and prognostic factors for adult patients with medulloblastoma: the Rare Cancer Network (RCN) experience. Radiother Oncol 127:96–102. https://doi.org/10.1016/j.radonc.2017.12.028 CrossRefPubMed

Brandes AA, Franceschi E (2014) Shedding light on adult medulloblastoma: current management and opportunities for advances. Am Soc Clin Oncol Educ Book:e82–e87. https://doi.org/10.14694/EdBook_AM.2014.34.e82

Park JE, Kang J, Yoo KH, Sung KW, Koo HH, Lim DH, Shin HJ, Kang HJ, Park KD, Shin HY, Kim IH, Cho BK, Im HJ, Seo JJ, Park HJ, Park BK, Ahn HS (2010) Efficacy of high-dose chemotherapy and autologous stem cell transplantation in patients with relapsed medulloblastoma: a report on the Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 study. J Korean Med Sci 25:1160–1166. https://doi.org/10.3346/jkms.2010.25.8.1160 CrossRefPubMedPubMedCentral

Dunkel IJ, Gardner SL, Garvin JH Jr, Goldman S, Shi W, Finlay JL (2010) High-dose carboplatin, thiotepa, and etoposide with autologous stem cell rescue for patients with previously irradiated recurrent medulloblastoma. Neuro-Oncology 12:297–303. https://doi.org/10.1093/neuonc/nop031 CrossRefPubMedPubMedCentral

Gururangan S, Krauser J, Watral MA, Driscoll T, Larrier N, Reardon DA, Rich JN, Quinn JA, Vredenburgh JJ, Desjardins A, McLendon RE, Fuchs H, Kurtzberg J, Friedman HS (2008) Efficacy of high-dose chemotherapy or standard salvage therapy in patients with recurrent medulloblastoma. Neuro-Oncology 10:745–751. https://doi.org/10.1215/15228517-2008-044 CrossRefPubMedPubMedCentral

10.

Bauman GS, Sneed PK, Wara WM, Stalpers LJ, Chang SM, McDermott MW, Gutin PH, Larson DA (1996) Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys 36:433–441CrossRefPubMed

11.

Abe M, Tokumaru S, Tabuchi K, Kida Y, Takagi M, Imamura J (2006) Stereotactic radiation therapy with chemotherapy in the management of recurrent medulloblastomas. Pediatr Neurosurg 42:81–88CrossRefPubMed

12.

Patrice SJ, Tarbell NJ, Goumnerova LC, Shrieve DC, Black PM, Loeffler JS (1995) Results of radiosurgery in the management of recurrent and residual medulloblastoma. Pediatr Neurosurg 22:197–203CrossRefPubMed

13.

Buglione M, Triggiani L, Grisanti S, Liserre R, Buttolo L, Gipponi S, Bonetti F, Todeschini A, Spiazzi L, Magrini SM (2013) Retreatment of recurrent adult medulloblastoma with radiotherapy: a case report and review of the literature. J Med Case Rep 7:64. https://doi.org/10.1186/1752-1947-7-64 CrossRefPubMedPubMedCentral

14.

Cieślak E, Kepka L, Fijuth J, Marchel A, Kroh H (2004) Very late relapse of medulloblastoma. Folia Neuropathol 42:49–53PubMed

15.

Bakst RL, Dunkel IJ, Gilheeney S, Khakoo Y, Becher O, Souweidane MM, Wolden SL (2011) Reirradiation for recurrent medulloblastoma. Cancer 117:4977–4982. https://doi.org/10.1002/cncr.26148 CrossRefPubMed

16.

Wetmore C, Herington D, Lin T, Onar-Thomas A, Gajjar A, Merchant TE (2014) Reirradiation of recurrent medulloblastoma: does clinical benefit outweigh risk for toxicity? Cancer 120:3731–3737. https://doi.org/10.1002/cncr.28907 CrossRefPubMedPubMedCentral

17.

Saran F, Baumert BG, Creak AL, Warrington AP, Ashley S, Traish D, Brada M (2008) Hypofractionated stereotactic radiotherapy in the management of recurrent or residual medulloblastoma/PNET. Pediatr Blood Cancer 50:554–560CrossRefPubMed

18.

Keshavarzi S, Meltzer H, Ben-Haim S, Newman CB, Lawson JD, Levy ML, Murphy K (2009) Initial clinical experience with frameless optically guided stereotactic radiosurgery/radiotherapy in pediatric patients. Childs Nerv Syst 25:837–844. https://doi.org/10.1007/s00381-009-0840-8 CrossRefPubMedPubMedCentral

19.

Chojnacka M, Skowrońska-Gardas A, Pędziwiatr K, Morawska-Kaczyńska M, Perek M, Perek D (2011) Reirradiation of relapsed brain tumors in children. Rep Pract Oncol Radiother 17:32–37. https://doi.org/10.1016/j.rpor.2011.10.004 CrossRefPubMedPubMedCentral

20.

Milker-Zabel S, Zabel A, Thilmann C, Zuna I, Hoess A, Wannenmacher M, Debus J (2002) Results of three-dimensional stereotactically-guided radiotherapy in recurrent medulloblastoma. J Neuro-Oncol 60:227–233CrossRef

21.

Privitera G, Acquaviva G, Ettorre GC, Spatola C (2009) Antiangiogenic therapy in the treatment of recurrent medulloblastoma in the adult: case report and review of the literature. J Oncol 2009:247873. https://doi.org/10.1155/2009/247873 CrossRefPubMedPubMedCentral

22.

Padovani L, Andre N, Gentet JC, Figarella Branger D, Scavarda D, Verschuur A, Chinot O, Cowen D, Muracciole X (2011) Reirradiation and concomitant metronomic temozolomide: an efficient combination for local control in medulloblastoma disease? J Pediatr Hematol Oncol 33:600–604. https://doi.org/10.1097/MPH.0b013e3182331eaf CrossRefPubMed

23.

Massimino M, Gandola L, Spreafico F, Biassoni V, Luksch R, Collini P, Solero CN, Simonetti F, Pignoli E, Cefalo G, Poggi G, Modena P, Mariani L, Potepan P, Podda M, Casanova M, Pecori E, Acerno S, Ferrari A, Terenziani M, Meazza C, Polastri D, Ravagnani F, Fossati-Bellani F (2009) No salvage using high-dose chemotherapy plus/minus reirradiation for relapsing previously irradiated medulloblastoma. Int J Radiat Oncol Biol Phys 73:1358–1363. https://doi.org/10.1016/j.ijrobp.2008.06.1930 CrossRefPubMed

24.

Massimino M, Casanova M, Polastri D, Biassoni V, Modena P, Pecori E, Schiavello E, De Pava MV, Indini A, Rampini P, Bauer D, Catania S, Podda M, Gandola L (2013) Relapse in medulloblastoma: what can be done after abandoning high-dose chemotherapy? A mono-institutional experience. Childs Nerv Syst 29:1107–1112. https://doi.org/10.1007/s00381-013-2104-x CrossRefPubMed

25.

Rao AD, Rashid AS, Chen Q, Villar RC, Kobyzeva D, Nilsson K, Dieckmann K, Nechesnyuk A, Ermoian R, Alcorn S, MacDonald SM, Ladra MM, Ford EC, Winey BA, Figueiredo MLS, Chen MJ, Terezakis SA (2017) Reirradiation for recurrent pediatric central nervous system malignancies: a multi-institutional review. Int J Radiat Oncol Biol Phys 99:634–641. https://doi.org/10.1016/j.ijrobp.2017.07.026 CrossRefPubMed

26.

Larysz D, Blamek S, Larysz P, Pietras K, Mandera M (2010) Posterior fossa brain tissue injury: developmental, neuropsychological, and neurological consequences of brain tumors in children. Acta Neurochir Suppl 106:271–274. https://doi.org/10.1007/978-3-211-98811-4_51 CrossRefPubMed

27.

Blamek S, Larysz D, Ficek K, Sokół M, Miszczyk L, Tarnawski R (2010) MR spectroscopic evaluation of brain tissue damage after treatment for pediatric brain tumors. Acta Neurochir Suppl 106:183–186. https://doi.org/10.1007/978-3-211-98811-4_33 CrossRefPubMed

28.

Boguszewicz L, Blamek S, Sokół M (2010) Pattern recognition methods in (1)H MRS monitoring in vivo of normal appearing cerebellar tissue after treatment of posterior fossa tumors. Acta Neurochir Suppl 106:171–175. https://doi.org/10.1007/978-3-211-98811-4_31 CrossRefPubMed

29.

Wen PY, Huse JT (2017) 2016 World Health Organization classification of central nervous system tumors. Continuum (Minneap Minn) 23:1531–1547. https://doi.org/10.1212/CON.0000000000000536 CrossRef

30.

Mayer R, Sminia P (2008) Reirradiation tolerance of the human brain. Int J Radiat Oncol Biol Phys 70:1350–1360CrossRefPubMed

Title: Radiosurgery or hypofractionated stereotactic radiotherapy after craniospinal irradiation in children and adults with medulloblastoma and ependymoma
Authors: Aleksandra Napieralska
Iwona Brąclik
Michał Radwan
Marek Mandera
Sławomir Blamek
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 2/2019
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-018-4010-8

At a glance: The STEP trials

Springer Medicine

Radiosurgery or hypofractionated stereotactic radiotherapy after craniospinal irradiation in children and adults with medulloblastoma and ependymoma

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2019

Outcomes from primary surgical reconstruction of neonatal brachial plexus palsy in 104 children

Decompressive craniectomy in paediatric traumatic brain injury: a systematic review of current evidence

Posterior circulation involvement and collateral flow pattern in moyamoya disease with the RNF213 polymorphism

Is arachnoid cyst a static disease? A case report and literature review

The quality of life in extracorporeal life support survivors: single-center experience of a long-term follow-up

Age-associated hippocampal volume changes in childhood arterial ischemic stroke