Treatment outcomes and late toxicities in patients with embryonal central nervous system tumors

Radiation Oncology

Tomio Inoue⁷  Hiroko Yuki⁸  Haruyasu Yoshida⁸  Masanori Adachi³  Susumu Ito⁴  Hiroaki Goto⁵  Tetsu Niwa¹  Noriko Aida²  Masaharu Hata⁷  Motoko Omura⁶  Kazumasa Odagiri² 

[1] Department of Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan;Department of Radiology, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, Japan;Department of Endocrinology and Metabolism, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, Japan;Department of Neurosurgery, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, Japan;Division of Hemato-Oncology/Regeneration Medicine, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, Japan;Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan;Department of Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan;Department of Radiation Technology, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, Japan

关键词: Cognitive function;    Ototoxicity;    Hypothyroidism;    Growth height;    Pineoblastoma;    Atypical teratoid/rhabdoid tumor;    Supratentorial primitive neuroectodermal tumor;    Medulloblastoma;    Embryonal central nervous system tumors;   

Others  :  1151375
DOI  :  10.1186/1748-717X-9-201

 received in 2014-01-07, accepted in 2014-08-31,  发布年份 2014

【 摘 要 】

Background

Standard treatment strategies for embryonal central nervous system (CNS) tumors have not yet been established. We treated these tumors using an original chemoradiation therapy protocol; the clinical outcomes and toxicities were retrospectively evaluated.

Methods

Twenty-four patients were enrolled including sixteen with medulloblastoma, four with supratentorial primitive neuroectodermal tumor (sPNET), three with atypical teratoid/rhabdoid tumor, and one with pineoblastoma. Immediately after diagnosis, all patients underwent surgery initially. They were then categorized as high- or average-risk groups independent of tumor type/pathogenesis. The average-risk group included patients who were aged ≥3 years at diagnosis, had non-metastatic disease at diagnosis (M0), and had undergone gross total resection. Other patients were categorized as the high-risk group; this group received more intensive treatment than the average-risk group, including high-dose chemotherapy with autologous stem-cell transplantation. All patients received craniospinal irradiation (CSI). The CSI dose was 23.4 Gy for M0 patients aged ≥5 years, 18 Gy for M0 patients aged <5 years, and 30–36 Gy for all patients with M + disease. The total dose to the primary tumor bed was 54 Gy.

Results

The median follow-up time was 73.5 (range, 19–118) months. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 71.1 and 88.9%, respectively in the average-risk group (n = 9) and 66.7 and 71.1%, respectively in the high-risk group (n = 15). The PFS and OS rates were not significantly different between the average- and high-risk groups. In patients with medulloblastoma only, these rates were also not significantly different between the average- and high-risk groups. Three of four patients with sPNET were disease free. The height standard deviation score (SDS) was significantly decreased at the last assessment relative to that at diagnosis (P < 0.0001). The latest median height SDS was -1.6 (range, 0.9 to -4.8), and the latest median full-scale intelligence quotient (FSIQ) score was 86 (range, 59–128). The CSI doses and age at the start of radiation therapy did not influence clinical outcomes, height SDSs, and FSIQ scores.

Conclusions

Our original protocol for patients with embryonal CNS tumors was feasible and yielded favorable clinical outcomes.

【 授权许可】

   
2014 Odagiri et al.; licensee BioMed Central Ltd.

【 图 表 】

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