Tejpal Gupta1, Babusha Kalra1, Savita Goswami2, Jayita Deodhar2, Pallavi Rane3, Sridhar Epari4, Aliasgar Moiyadi5, Archya Dasgupta1, Abhishek Chatterjee1, Girish Chinnaswamy6. 1. Department of Radiation Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India. 2. Clinical Psychology & Psychiatry Unit, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India. 3. Clinical Research Secretariat, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India. 4. Department of Pathology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India. 5. Department of Neuro-Surgery, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India. 6. Department of Pediatric Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India.
Abstract
Background: The purpose of this study was to report long-term neurocognitive and clinical outcomes in children treated for average-risk medulloblastoma with hyperfractionated radiation therapy (HFRT) alone. Methods: Between 2006 and 2010, 20 children with rigorously staged average-risk medulloblastoma were treated on a prospective study with HFRT without upfront adjuvant systemic chemotherapy after written informed consent. HFRT was delivered as twice-daily fractions (1 Gy/fraction, 6-8 hours apart, 5 days/week) to craniospinal axis (36 Gy/36 fractions) plus conformal tumor-bed boost (32 Gy/32 fractions). Neurocognitive function was assessed at baseline and periodically on follow-up using age-appropriate intelligence quotient (IQ) scales. Results: Median age was 8 years (range 5-14 years) with 70% being males. Mean and standard deviation (SD) scores at baseline were 90.5 (SD = 17.08), 88 (SD = 16.82) and 88 (SD = 17.24) for Verbal Quotient (VQ), Performance Quotient (PQ), and Full-Scale IQ (FSIQ) respectively. Mean scores remained stable in the short-to-medium term but declined gradually beyond 5 years with borderline statistical significance for VQ (P = .042), but nonsignificant decline in PQ (P = .259) and FSIQ (P = .108). Average rate of neurocognitive decline was <1 IQ point per year over a 10-year period. Regression analysis stratified by age, gender, and baseline FSIQ failed to demonstrate any significant impact of the tested covariates on longitudinal neurocognitive function. At a median follow-up of 145 months, 10-year Kaplan-Meier estimates of progression-free survival and overall survival were 63.2% and 74.1% respectively. Conclusion: HFRT alone without upfront adjuvant chemotherapy in children with average-risk medulloblastoma is associated with modest decline in neurocognitive functioning with acceptable long-term survival outcomes and may be most appropriate for resource-constrained settings.
Background: The purpose of this study was to report long-term neurocognitive and clinical outcomes in children treated for average-risk medulloblastoma with hyperfractionated radiation therapy (HFRT) alone. Methods: Between 2006 and 2010, 20 children with rigorously staged average-risk medulloblastoma were treated on a prospective study with HFRT without upfront adjuvant systemic chemotherapy after written informed consent. HFRT was delivered as twice-daily fractions (1 Gy/fraction, 6-8 hours apart, 5 days/week) to craniospinal axis (36 Gy/36 fractions) plus conformal tumor-bed boost (32 Gy/32 fractions). Neurocognitive function was assessed at baseline and periodically on follow-up using age-appropriate intelligence quotient (IQ) scales. Results: Median age was 8 years (range 5-14 years) with 70% being males. Mean and standard deviation (SD) scores at baseline were 90.5 (SD = 17.08), 88 (SD = 16.82) and 88 (SD = 17.24) for Verbal Quotient (VQ), Performance Quotient (PQ), and Full-Scale IQ (FSIQ) respectively. Mean scores remained stable in the short-to-medium term but declined gradually beyond 5 years with borderline statistical significance for VQ (P = .042), but nonsignificant decline in PQ (P = .259) and FSIQ (P = .108). Average rate of neurocognitive decline was <1 IQ point per year over a 10-year period. Regression analysis stratified by age, gender, and baseline FSIQ failed to demonstrate any significant impact of the tested covariates on longitudinal neurocognitive function. At a median follow-up of 145 months, 10-year Kaplan-Meier estimates of progression-free survival and overall survival were 63.2% and 74.1% respectively. Conclusion: HFRT alone without upfront adjuvant chemotherapy in children with average-risk medulloblastoma is associated with modest decline in neurocognitive functioning with acceptable long-term survival outcomes and may be most appropriate for resource-constrained settings.
Authors: Anita Mahajan; Peter L Stavinoha; Warissara Rongthong; N Patrik Brodin; Susan L McGovern; Issam El Naqa; Joshua D Palmer; Sabina Vennarini; Daniel J Indelicato; Paul Aridgides; Daniel C Bowers; Leontien Kremer; Cecile Ronckers; Louis Constine; Michele Avanzo Journal: Int J Radiat Oncol Biol Phys Date: 2021-03-09 Impact factor: 7.038
Authors: Cassie N Kline; Roger J Packer; Eugene I Hwang; David R Raleigh; Steve Braunstein; Corey Raffel; Pratiti Bandopadhayay; David A Solomon; Mariam Aboian; Soonmee Cha; Sabine Mueller Journal: Neurooncol Pract Date: 2017-08-11
Authors: Hugo Câmara-Costa; Kim S Bull; Colin Kennedy; Andreas Wiener; Gabriele Calaminus; Anika Resch; Virginie Kieffer; Clémence Lalande; Geraldina Poggi; Katja von Hoff; Jacques Grill; François Doz; Stefan Rutkowski; Maura Massimino; Rolf-Dieter Kortmann; Birgitta Lannering; Georges Dellatolas; Mathilde Chevignard Journal: Neurooncol Pract Date: 2017-02-10
Authors: Cynthia B de Medeiros; Iska Moxon-Emre; Nadia Scantlebury; David Malkin; Vijay Ramaswamy; Alexandra Decker; Nicole Law; Toshihiro Kumabe; Jeffrey Leonard; Josh Rubin; Shin Jung; Seung-Ki Kim; Nalin Gupta; William Weiss; Claudia C Faria; Rajeev Vibhakar; Lucie Lafay-Cousin; Jennifer Chan; Johan M Kros; Laura Janzen; Michael D Taylor; Eric Bouffet; Donald J Mabbott Journal: Cancer Med Date: 2019-11-21 Impact factor: 4.452