PURPOSE: Necrosis of the central nervous system (CNS) is a known complication of craniospinal irradiation (CSI) in children with medulloblastoma and similar tumors. We reviewed the incidence of necrosis in our prospective treatment series. PATIENTS AND METHODS: Between 1996 and 2009, 236 children with medulloblastoma (n = 185) or other CNS embryonal tumors (n = 51) received postoperative CSI followed by dose-intense cyclophosphamide, vincristine, and cisplatin. Average risk cases (n = 148) received 23.4 Gy CSI, 36 Gy to the posterior fossa, and 55.8 Gy to the primary; after 2003, the treatment was 23.4 Gy CSI and 55.8 Gy to the primary. All high-risk cases (n = 88) received 36-39.6 Gy CSI and 55.8 Gy primary. The primary site clinical target volume margin was 2 cm (pre-2003) or 1 cm (post-2003). With competing risk of death by any cause, we determined the cumulative incidence of necrosis. RESULTS: With a median follow-up of 52 months (range, 4-163 months), eight cases of necrosis were documented. One death was attributed. The median time to the imaging evidence was 4.8 months and to symptoms 6.0 months. The cumulative incidence at 5 years was 3.7% ± 1.3% (n = 236) for the entire cohort and 4.4% ± 1.5% (n = 196) for infratentorial tumor location. The mean relative volume of infratentorial brain receiving high-dose irradiation was significantly greater for patients with necrosis than for those without: ≥ 50 Gy (92.12% ± 4.58% vs 72.89% ± 1.96%; P=.0337), ≥ 52 Gy (88.95% ± 5.50% vs 69.16% ± 1.97%; P=.0275), and ≥ 54 Gy (82.28% ± 7.06% vs 63.37% ± 1.96%; P=.0488), respectively. CONCLUSIONS: Necrosis in patients with CNS embryonal tumors is uncommon. When competing risks are considered, the incidence is 3.7% at 5 years. The volume of infratentorial brain receiving greater than 50, 52, and 54 Gy, respectively, is predictive for necrosis.
PURPOSE:Necrosis of the central nervous system (CNS) is a known complication of craniospinal irradiation (CSI) in children with medulloblastoma and similar tumors. We reviewed the incidence of necrosis in our prospective treatment series. PATIENTS AND METHODS: Between 1996 and 2009, 236 children with medulloblastoma (n = 185) or other CNS embryonal tumors (n = 51) received postoperative CSI followed by dose-intense cyclophosphamide, vincristine, and cisplatin. Average risk cases (n = 148) received 23.4 Gy CSI, 36 Gy to the posterior fossa, and 55.8 Gy to the primary; after 2003, the treatment was 23.4 Gy CSI and 55.8 Gy to the primary. All high-risk cases (n = 88) received 36-39.6 Gy CSI and 55.8 Gy primary. The primary site clinical target volume margin was 2 cm (pre-2003) or 1 cm (post-2003). With competing risk of death by any cause, we determined the cumulative incidence of necrosis. RESULTS: With a median follow-up of 52 months (range, 4-163 months), eight cases of necrosis were documented. One death was attributed. The median time to the imaging evidence was 4.8 months and to symptoms 6.0 months. The cumulative incidence at 5 years was 3.7% ± 1.3% (n = 236) for the entire cohort and 4.4% ± 1.5% (n = 196) for infratentorial tumor location. The mean relative volume of infratentorial brain receiving high-dose irradiation was significantly greater for patients with necrosis than for those without: ≥ 50 Gy (92.12% ± 4.58% vs 72.89% ± 1.96%; P=.0337), ≥ 52 Gy (88.95% ± 5.50% vs 69.16% ± 1.97%; P=.0275), and ≥ 54 Gy (82.28% ± 7.06% vs 63.37% ± 1.96%; P=.0488), respectively. CONCLUSIONS:Necrosis in patients with CNS embryonal tumors is uncommon. When competing risks are considered, the incidence is 3.7% at 5 years. The volume of infratentorial brain receiving greater than 50, 52, and 54 Gy, respectively, is predictive for necrosis.
Authors: Yaacov Richard Lawrence; X Allen Li; Issam el Naqa; Carol A Hahn; Lawrence B Marks; Thomas E Merchant; Adam P Dicker Journal: Int J Radiat Oncol Biol Phys Date: 2010-03-01 Impact factor: 7.038
Authors: E Shaw; R Arusell; B Scheithauer; J O'Fallon; B O'Neill; R Dinapoli; D Nelson; J Earle; C Jones; T Cascino; D Nichols; R Ivnik; R Hellman; W Curran; R Abrams Journal: J Clin Oncol Date: 2002-05-01 Impact factor: 44.544
Authors: Patricia L Robertson; Karin M Muraszko; Emiko J Holmes; Richard Sposto; Roger J Packer; Amar Gajjar; Mark S Dias; Jeffrey C Allen Journal: J Neurosurg Date: 2006-12 Impact factor: 5.115
Authors: R J Packer; J Goldwein; H S Nicholson; L G Vezina; J C Allen; M D Ris; K Muraszko; L B Rorke; W M Wara; B H Cohen; J M Boyett Journal: J Clin Oncol Date: 1999-07 Impact factor: 44.544
Authors: Murali Chintagumpala; Tim Hassall; Shawna Palmer; David Ashley; Dana Wallace; Kimberly Kasow; Thomas E Merchant; Matthew J Krasin; Robert Dauser; Frederick Boop; Robert Krance; Shiao Woo; Robyn Cheuk; Ching Lau; Richard Gilbertson; Amar Gajjar Journal: Neuro Oncol Date: 2008-09-16 Impact factor: 12.300
Authors: Thomas E Merchant; Ramana M Chitti; Chenghong Li; Xiaoping Xiong; Robert A Sanford; Raja B Khan Journal: Int J Radiat Oncol Biol Phys Date: 2009-05-21 Impact factor: 7.038
Authors: Maria Camilla Rossi Espagnet; Luca Pasquini; Antonio Napolitano; Antonella Cacchione; Angela Mastronuzzi; Roberta Caruso; Paolo Tomà; Daniela Longo Journal: Pediatr Radiol Date: 2016-12-09
Authors: Rituraj Upadhyay; Kaiping Liao; David R Grosshans; Susan L McGovern; Mary Frances McAleer; Wafik Zaky; Murali M Chintagumpala; Anita Mahajan; Debra Nana Yeboa; Arnold C Paulino Journal: Neuro Oncol Date: 2022-09-01 Impact factor: 13.029
Authors: Sujith Baliga; Sara Gallotto; Benjamin Bajaj; Jacqueline Lewy; Elizabeth Weyman; Miranda P Lawell; Beow Y Yeap; David E Ebb; Mary Huang; Paul Caruso; Alisa Perry; Robin M Jones; Shannon M MacDonald; Nancy J Tarbell; Torunn I Yock Journal: Neuro Oncol Date: 2022-06-01 Impact factor: 13.029
Authors: J H Harreld; P Zou; N D Sabin; A Edwards; Y Han; Y Li; O Bieri; R B Khan; A Gajjar; G Robinson; T E Merchant Journal: AJNR Am J Neuroradiol Date: 2022-01-20 Impact factor: 3.825