Klaus Müller1, Martin Mynarek2, Isabella Zwiener3, Nele Siegler4, Martina Zimmermann5, Hans Christiansen6, Wilfried Budach7, Guido Henke8, Monika Warmuth-Metz9, Torsten Pietsch10, Katja von Hoff2, Andre von Bueren11, Udo Bode5, Stefan Rutkowski2, Rolf-Dieter Kortmann12, Gudrun Fleischhack4, Stephan Tippelt4. 1. Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany. Electronic address: Klaus.Mueller@medizin.uni-leipzig.de. 2. Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz Medical Center, Mainz, Germany. 4. University Hospital of Essen, Pediatrics III, Essen, Germany. 5. Department of Pediatric Hematology and Oncology, Children's Hospital, University Hospital of Bonn, Bonn, Germany. 6. Department of Radiotherapy, Hannover Medical School, Hannover, Germany. 7. Clinic and Policlinic for Radiation Therapy and Radiooncology, University of Düsseldorf, Düsseldorf, Germany. 8. Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 9. Department of Neuroradiology, University of Würzburg, Würzburg, Germany. 10. Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany. 11. Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany. 12. Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany.
Abstract
PURPOSE: To evaluate the efficacy of craniospinal irradiation (CSI) in the management of recurrent infant medulloblastoma after surgery and chemotherapy alone. METHODS AND MATERIALS: Seventeen pediatric medulloblastoma patients registered in the HIT-REZ 1997 and 2005 studies underwent CSI as salvage treatment at first recurrence. All patients had achieved complete remission after first-line treatment consisting of surgery and chemotherapy. Eleven patients showed metastatic disease at relapse. Five patients underwent surgery prior to radiation therapy, which resulted in complete resection in 1 case. In 1 patient, complete resection of the residual tumor was performed after CSI. Eleven patients received chemotherapy prior, 6 patients during and 8 patients after CSI. All patients received CSI with a median total dose of 35.2 Gy, and all but 1 received a boost to the posterior fossa (median total dose, 55.0 Gy). Metastases were boosted with an individual radiation dose, depending on their location and extent. RESULTS: During a median follow-up time of 6.2 years since recurrence, 11 patients showed progressive disease and died. Median progression-free (overall) survival was 2.9 ± 1.1 (3.8 ± 0.8) years. Progression-free survival (PFS) rates at 1, 3, and 5 years were 88% ± 8%, 46% ± 12%, and 40% ± 12%, respectively. Overall survival (OS) rates at 1, 3, and 5 years were 94% ± 6%, 58% ± 12%, and 39% ± 12%, respectively. For 11 patients with classic medulloblastoma, 3-year (and 5-year) PFS and OS were 62% ± 15% and 72% ± 14% (52% ± 16% and 51% ± 16%), respectively. On univariate analysis, metastatic disease was not associated with poorer progression-free and overall survival. CONCLUSIONS: Our results suggest that salvage treatment of relapsed medulloblastomas consisting of CSI and chemotherapy offers a second chance for cure, even for patients with classic histological findings. Metastatic disease at relapse did not have an impact on survival. However, this may be explained by the small number of patients.
PURPOSE: To evaluate the efficacy of craniospinal irradiation (CSI) in the management of recurrent infantmedulloblastoma after surgery and chemotherapy alone. METHODS AND MATERIALS: Seventeen pediatric medulloblastomapatients registered in the HIT-REZ 1997 and 2005 studies underwent CSI as salvage treatment at first recurrence. All patients had achieved complete remission after first-line treatment consisting of surgery and chemotherapy. Eleven patients showed metastatic disease at relapse. Five patients underwent surgery prior to radiation therapy, which resulted in complete resection in 1 case. In 1 patient, complete resection of the residual tumor was performed after CSI. Eleven patients received chemotherapy prior, 6 patients during and 8 patients after CSI. All patients received CSI with a median total dose of 35.2 Gy, and all but 1 received a boost to the posterior fossa (median total dose, 55.0 Gy). Metastases were boosted with an individual radiation dose, depending on their location and extent. RESULTS: During a median follow-up time of 6.2 years since recurrence, 11 patients showed progressive disease and died. Median progression-free (overall) survival was 2.9 ± 1.1 (3.8 ± 0.8) years. Progression-free survival (PFS) rates at 1, 3, and 5 years were 88% ± 8%, 46% ± 12%, and 40% ± 12%, respectively. Overall survival (OS) rates at 1, 3, and 5 years were 94% ± 6%, 58% ± 12%, and 39% ± 12%, respectively. For 11 patients with classic medulloblastoma, 3-year (and 5-year) PFS and OS were 62% ± 15% and 72% ± 14% (52% ± 16% and 51% ± 16%), respectively. On univariate analysis, metastatic disease was not associated with poorer progression-free and overall survival. CONCLUSIONS: Our results suggest that salvage treatment of relapsed medulloblastomas consisting of CSI and chemotherapy offers a second chance for cure, even for patients with classic histological findings. Metastatic disease at relapse did not have an impact on survival. However, this may be explained by the small number of patients.
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Authors: Holger Ottensmeier; Paul G Schlegel; Matthias Eyrich; Johannes E Wolff; Björn-Ole Juhnke; Katja von Hoff; Stefanie Frahsek; Rene Schmidt; Andreas Faldum; Gudrun Fleischhack; Andre von Bueren; Carsten Friedrich; Anika Resch; Monika Warmuth-Metz; Jürgen Krauss; Rolf D Kortmann; Udo Bode; Joachim Kühl; Stefan Rutkowski Journal: PLoS One Date: 2020-01-23 Impact factor: 3.240