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Treatment of pediatric average-risk medulloblastoma using craniospinal irradiation less than 2500 cGy and chemotherapy: single center experience in Korea

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World Journal of Pediatrics 2017年第4期13卷 367-373页

作者： Jong Hyung Yoon Kyung Duk Park Hyoung Jin Kang Hyery Kim Ji Won Lee Seung-Ki Kim Kyu-Chang Wang Sung-Hye Park Il Han Kim Hee Young Shin Department of Pediatrics Cancer Research InstituteSeoul National University College of MedicineSeoul Department of Pediatrics Hallym University College of medicineChuncheon Sacred Heart HospitalChuncheonKorea Departments of Neurosurgery Seoul National University College of MedicineSeoul Pathology Seoul National University College of MedicineSeoul Radiation Oncology Seoul National University College of MedicineSeoul

Background:Although craniospinal irradiation (CSI) of 2340 cGy plus tumor booster with chemotherapy have been established as a standard treatment of childhood average-risk (AvR) medulloblastoma (MBL) in Western counties,there are a few recent reports in outcomes ofAvR MBL using this strategy in Korean and other Asian *** investigated the outcome of the Korean children with AvR MBL who were treated with CSI <2500 cGy and ***:Between January 2001 and December 2010,clinical characteristics and outcomes of 42 patients who were diagnosed with AvR MBL postoperatively and treated with radiation including CSI <2500 cGy and chemotherapy in Seoul National University Children's Hospital were ***:Their median age was 9 years (range:3-18.8),and 29 were *** subtypes were classic type in 28 patients,nodular/desmoplastic in 7,and large cell/anaplastic (LCA) in *** the patients received adjuvant radiotherapy (CSI with median 2340 cGy and booster) and multiagent chemotherapy as the first-fine *** a median follow-up of 54 months,12 patients experienced relapse or progression of the *** 3-and 5-year disease-free survival (DFS) rates were 78.0%±6.5% and 75.0%±6.9%,respectively,and overall survival (OS) rates were 85.3%±5.6% and 76.8%±6.9%,*** LCA subtype was associated with poorer DFS (P=0.023) and OS (P=0.008),compared with non-LCA ***:The outcomes of children and adolescents with AvR MBL treated with radiation including CSI <2500 cGy and chemotherapy,are compatible to those in Western countries;however,the LCA subtype has a poor outcome with this strategy.

关键词： average-risk craniospinal irradiation medulloblastoma

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The Effect of Absorbed Dose to Organs at Risk Following craniospinal Irradiation Using Different Radiotherapy Techniques

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2020年第2期9卷 73-85页

作者： Hadeer A. Shahin Ehab M. Attalla H. S. Abou-Elenien Hussein Elsayed Ibrahim Bashter Marwa A. Suliman Physics Department Faculty of Science Zagazig University Zagazig Egypt Radiotherapy Department National Cancer Institute Cairo Egypt Radiotherapy Department Children’s Cancer Hospital Cairo Egypt Clinical Oncology & Nuclear Medicine Department Faculty of Medicine Suez Canal University Ismailia Egypt

Introduction: In medulloblastoma patients craniospinal irradiation is an important element the treatment. Our study aimed to evaluate the effect of absorbed dose to organs at risk using the hybrid intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiotherapy (3DCRT) for craniospinal irradiation (CSI) in average risk medulloblastoma patients. Materials and Methods: In this study, thirteen medulloblastoma patients were included. The prescribed total dose to the planning target volume (PTV) was 23, 40 Gy in 13 fractions. Two radiotherapy techniques, three dimensional conformal radiotherapy (3DCRT) and hybrid intensity modulated radiotherapy (IMRT) were used to treat these patients. The coverage of the Target was evaluated using the D mean, D95%, D2%, D98% and V95%. Other parameters were also compared such as Integral dose (ID), Homogeneity index (HI) and doses to the organs at risk (OARs). Results: There was no significant difference in the mean dose received by the PTV-Brain or the dose received by 95% and 98% of PTV volume using the two techniques. For PTV-Spine, the percentage volume receiving 95% of the total dose increased significantly in the hybrid IMRT technique compared to the conformal technique. So, hybrid IMRT plan achieved the best coverage for PTV spine. Lower dose for OAR was delivered by 3DCRT, except the heart and thyroid, hybrid IMRT achieved better sparing. All plans resulted in the same dose homogeneity index (DHI) for PTV-Brain. For PTV-Spine, hybrid IMRT technique achieved better dose homogeneity compared to 3DCRT technique (1.09 vs. 1.12;p > 0.05). Conclusions: hybrid IMRT technique can be realized on conformal technique because it achieved better dose coverage for the (PTV) and organ at risk (OAR). 3DCRT reduced mean dose to most OARS, except the heart and thyroid. Therefore, the hybrid IMRT technique may be a CSI treatment alternative to 3DCRT.

关键词： craniospinal Irradiation Three-Dimensional Conformal Radiotherapy Intensity-Modulated Radiation Therapy Medulloblastoma Organs at Risk Homogeneity Index

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Treatment Outcome and Prognostic Factors for Pediatric Medulloblastoma Patients: The Egyptian National Cancer Institute Experience

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Journal of Cancer Therapy 2017年第8期8卷 699-713页

作者： Ehab Elkest Amr Amin Mohamed Zaza Radiation Oncology and Nuclear Medicine Department National Cancer Institute Cairo University Cairo Egypt

Purpose: To evaluate treatment outcomes and prognostic factors of pediatric Medulloblastoma (MB) patients treated by adjuvant post-operative riskadapted radiotherapy (RT) and chemotherapy (CT). Patients and Methods: A retrospective analysis was conducted based on medical records of pediatric patients with pathologically confirmed MB treated between 2006 and 2013 at the National cancer Institute (NCI), Egypt. Various patients’ and disease characteristics, treatment details and outcome data were reviewed. Results: Fifty patients’ records were included in the analysis with a median age of 6 years at diagnosis (range 3 - 18). According to the Chang staging system;38%, 44%, 4%, and 14% were M0, M1, M2, and M3, respectively. All patients underwent primary surgery;gross total resection (with no residual) in 38%, near total resection (with residual ≤1.5 cm2) in 8%, subtotal resection (with residual > 1.5 cm2) in 34%, and 20% had only biopsy. All patients were treated by riskadapted craniospinal irradiation (CSI);high-risk patients were treated by CSI 36 Gy/20 fractions over 4 weeks followed by posterior fossa (PF) boost 18 Gy/10 fractions over 2 weeks (180 cGy per fraction), while standard-risk patients were treated by CSI 23.4 Gy/13 fractions over 2 and half weeks followed by PF boost 30.6 Gy/17 fractions over 3 and half weeks. Median overall treatment time (OTT) was 52 days. All patients received adjuvant CT;47 patients (94%) received concomitant chemo radiotherapy (CCRT), while 4 patients (8%) only received neoadjuvant CT (NB: only one patient received all neoadjuvant, concomitant and adjuvant CT). With a median follow up time of 32.5 months, ranging from 6 to 104 months, the whole group estimates of the overall survival (OS) at 1, 3, and 5 years were 83%, 70%, and 64%, respectively, while, the progression-free survival (PFS) rates at 1, 3, and 5 years were 79%, 62%, and 57% respectively. Four patients relapsed. Neural-axis was the commonest site of relapse (3 patients).

关键词： Pediatric Medulloblastoma craniospinal Irradiation Treatment Outcome Prognostic Factors

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