Promising survival rate but high incidence of treatment‐related mortality after reduced‐dose craniospinal radiotherapy and tandem high‐dose chemotherapy in patients with high‐risk medulloblastoma

Cancer Medicine

Hyung Jin Shin¹  Yeon‐Lim Suh²  Hee Won Cho³  Hee Young Ju³  Ji Won Lee³  Ki Woong Sung³  Ju Kyung Hyun³  Keon Hee Yoo³  Hong Hoe Koo³  Yoo‐Sook Joung⁴  Do Hoon Lim⁵ 

[1] Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea;Department of Pathology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea;Department of Pediatrics Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea;Department of Psychiatry Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea;Department of Radiation Oncology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea;

关键词: craniospinal radiotherapy;    high‐dose chemotherapy;    long‐term follow‐up;    medulloblastoma;    treatment‐related mortality;   

DOI  :  10.1002/cam4.3199

来源: DOAJ

【 摘 要 】

Abstract Background In this study, we report the follow‐up results of reduced dose of craniospinal radiotherapy (CSRT) followed by tandem high‐dose chemotherapy (HDCT) in patients with high‐risk medulloblastoma (MB). Methods Newly diagnosed high‐risk MB patients (metastatic disease, postoperative residual tumor >1.5 cm2, or large cell/anaplastic histology) over 3 years of age were enrolled in this study. Two cycles of pre‐RT chemotherapy, radiotherapy (RT) including reduced‐dose CSRT (23.4 or 30.6 Gy), four cycles of post‐RT chemotherapy, and tandem HDCT were administered. NanoString and DNA sequencing were performed using archival tissues. Results In all, 40 patients were enrolled, and molecular subgrouping was possible in 21 patients (2 wingless, 3 sonic hedgehog, 8 Group 3, and 8 group 4). All patients including two patients who experienced progression during the induction chemotherapy underwent HDCT. Relapse/progression occurred only in four patients (5‐year cumulative incidence [CI] 10.4 ± 0.3%). However, six patients died from treatment‐related mortality (TRM) (four acute TRMs and two late TRMs) resulting in 18.5 ± 0.5% of 5‐year CI. Taken together, the 5‐year event‐free survival and overall survival were 71.1 ± 8.0% and 73.2 ± 7.9%, respectively. Late effects were evaluated in 25 patients and high‐tone hearing loss, endocrine dysfunction, dyslipidemia, and growth retardation were common. Conclusions The strategy using tandem HDCT following reduced‐dose CSRT showed promising results in terms of low relapse/progression rate; however, the high TRM rate indicates that modification of HDCT regimen and careful selection of patients who can benefit from HDCT will be needed in the future study.

【 授权许可】

Unknown