Craniospinal Irradiation in Children with Medulloblastoma in Supine Position: Long-Term Results

Česká verzia

Authors: P. Šlampa ¹; K. Zitterbart ²; L. Dušek ³; O. Magnová ²; H. Doleželová ¹; P. Čoupek ¹; P. Pospíšil ¹; Š. Sovadinová ¹; Z. Pavelka ²; J. Štěrba ²; M. Chrenko ¹; K. Miklóšová ¹
Authors place of work: Odd. radiační onkologie, Masarykův onkologický ústav, Brno ¹; Klinika dětské onkologie, LF MU a FN Brno ²; Centrum informatiky a analýz, Masarykova univerzita, Brno ³
Published in the journal: Cesk Slov Neurol N 2007; 70/103(3): 308-314
Category: Short Communication

Summary

Radiotherapy is an essential method of treatment for medulloblastoma, but the surgery is the primary treatment of choice in the disorder mentioned. In this study, a total number of 33 pediatric patients under 15 years (median age 8.7 years) were irradiated post-operatively within January 1997 and March 2005. All tumors were located infratentorially in the posterior fossa. Chemotherapy was administered in 26 patients (78 %). The patients with craniospinal irradiation were placed in supine position and fixed with a vacuum-form body immobilizer and a head mask. Irradiation was delivered using a planned dose 26–30 Gy with standard 1.3–1.8 Gy daily fractions for the craniospinal axis with photon beam (6 MV). The median overall survival for the whole group was 55.3 months. The median disease-free survival was 20.6 months, 8 patients (24 %) died. No statistical difference in survival rate between standard and high-risk patients was shown. No relationship was found between survival and age, sex or the tumor size. Endocrine deficits occurred in 30% (8 patients of the group were hypothyroid, growth retardation occurred in 7 patients). Our therapeutical results (those of overall and disease-free survival) and side-effects of the craniospinal axis irradiation technique in supine position are comparable with the treatment results and technique toxicity in prone position.

Key words:
medulloblastoma – radiotherapy – craniospinal irradiation

Zdroje

1. Boom HJG, Glees J, Bell J. The treatment and long-term prognosis of children with intracranial tumors.A study of 610 cases, 1950-1981. Int J Rad Oncol Biol Phys 1990; 18: 723-45.

2. Freeman CR, Taylor RE, Kortmann RD, Carrie Ch. Radiotherapy for medulloblastoma in children: A perspective on current international clinical research efforts. Med Pediatr Oncol 2002; 39: 99-108.

3. Rood BR, MacDonald TJ, Packer RJ. Current treatment of medulloblastoma: Recent advances and future challanges. Semin Oncol 2004; 31: 666-75.

4. Gilbertson RJ. Medulloblastoma: signalling a change in treatment. The Lancet Oncology 2004; 5: 209-18.

5. Stiller CA, Bunch KJ. Trends in survival for childhood cancer in Britain diagnosed 1971-85. Br J Cancer 1990; 62: 806-15.

6. Thomas PRM, Deutsch M, Kepner JL, James M, Boyett M. Low-stage medulloblastoma: final analysis of trial camparing standard-dose with reduced-dose neuraxis irradiation. J Clin Oncol 2000; 18: 3004-11.

7. Duffner PK, Horowitz ME, Krischer JP, Friedman S. Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumore. N Engl J Med 1993; 328: 1725-31.

8. Bergman I, Jakacki RI, Heller G, Finlay J. Treatment of standard risk medulloblastoma with craniospinal irradiation, carboplatin, and vincristine. Med Pediatr Oncol 1997; 29: 563-7.

9. Kortmann RD, Kuhl J, Timmermann B, Mittler U, Urban C, Budach V et al. Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT´91. Int J Radiat Oncol Biol Phys 2000; 46: 269-79.

10. Corrias A, Picco P, Einaudi S. Growth hormone treatment in irradiated children with brain tumors. J Pediatr Endocrinol Metab 1997; 10: 41-9.

11. Chin D, Sklar C, Donahue B, Naaveen U, Geneiser N, Allen J et al. Thyroid dysfunction as a late effect in survivors of pediatric medulloblastoma/primitive neuroectodermal tumors: a comparison of hyperfractionated versus convectional radiotherapy. Cancer 1997; 80: 798-804.

12. Jannoun L, Boom HJG. Long-term psychological effects in children treated for intracranial tumors. Int J Rad Oncol Biol Phys 1990; 18: 747-53.

13. Sarah FH, Driever PH, Thilmann C, Mose S, Wilson P, Sharpe G et al. Survival of very young children with medulloblastoma (PNET of the posterior fossa) treated with craniospinal irradiation. Int J Radiat Oncol Biol Phys 1998; 42: 959-67.

14. Ribi K, Relly C, Landolt MA, Alber FD, Boltshauser E, Groetzer M et al. Outcome of medulloblastoma in children: long-term complications and quality of life. Neuropediatrics 2005; 36: 357-65.

15. David KM, Carey AT, Hayward RD. Medulloblastoma: is the 5-years survival rate improving ? A rewiev of 80 cases from a single institution. J Neurosurg 1997; 86: 13-21.

16. Taylor RE. The SIOP/UKCCSG PNET strategy and future SIOP medulloblastoma studies. Med Pediatr Oncol 2000; 35: 220.

17. Miralbell R, Bleher A, Huquenin P, Ries G, Kann R, Mirimanoff R et al. Pediatric medulloblastoma: radiation treatment technique and patterns of failure. Int J Rad Oncol Biol Phys 1997; 37: 523-9.

18. Griffiths SE, Short ChA. Radiotherapy: Principles to Practice. First Ed. Edinburgh: Churchill Livingstone 1994.

19. Goldwein JW, Ratcliffe J, Johnson J, Moshang T, Pacher RJ, Sutton LN et al. Uptadet results of a pilot study of low dose craniospinal irradiation plus chemotherapy for children under five years with cerebellar primitive neuroectodermal tumors (medulloblastoma). Int J Rad Oncol Biol, Phys 1996; 34: 899-904.

20. Marymont MH, Geohas J, Tomita T. Hyperfractionated craniospinal radiation in medulloblastoma. Pediatr Neurosurg 1996; 24: 178-84.

21. Hawkins R. A simple method of radiation treatment of craniospinal fields with patient supine. Int J Rad. Oncol Biol Phys 2001; 49: 261-4.

22. Slampa P, Seneklova Z, Sterba J, Dembicka D, Burianova L, Burkon P et al. The new technique of craniospinal irradiation. Med Pediatr Oncol 2000; 35: 318.

23. Slampa P, Burkon P, Sterba J, Petera J, Seneklova Z, Dembicka D et al. The technique of craniospinal irradiation in the management of intracranial ependymomas. J BUON 2002; 7: 131-6.

24. Šlampa P, Pecina J, Vývoda M. Využití vakuových dlah při ozařování. Klinická onkologie 1992; 5: 154-6.

25. Allen JC, Donahue B, Da Rosso G, Nierenberg A. Hyperfractionated craniospinal radiation and adjuvant chemotherapy for children with newly diagnosed medulloblastoma and other primitive neuroectodermal tumors. Int J Rad Oncol Biol Phys 1996; 36: 1155-61.

26. Penzzotta S, Cordero ML, Knerich R. CNS-85 trial: a cooperative pediatric CNS tumor study - results of treatment of medulloblastoma patients. Childs Nerv Syst 1996; 12: 87-96.

27. Rades D, Baumann R, Bremer M, Lehwer M, Karstens JH et al. Application of a new verification technique allowing craniospinal irradiation in supine position. Radiother Oncol 2001; 58: 217.

28. Bolek-Gorska M, Korab-Chrzanowska E, Zcepko R, Betlej M, Adamek D, Pawlega J. Medulloblastoma in adults. A case presentation and rewiev of the literature. Rep Pract Oncol Radiother, 2006; 11: 49-54.

29. Huang E, Teh BS, Strother DR, Davis QG, Chiu JK, Carpenter LS et al. Intensity-modulated radiation therapy for pediatric medulloblastoma: Early report on the reduction of ototoxicity. Int J Rad Oncol Biol Phys 2002; 52: 599-605.

30. Parker WA, Freeman CR. A simple technique for craniospinal radiotherapy in the supine position. Radiot Oncol 2006; 78: 217-22.