Abstract
Simple SummaryMedulloblastoma (MB) is one of the most common pediatric brain tumors. Surgical resection, followed by radiotherapy (RT) and chemotherapy, are the standard of care for medulloblastoma patients. This retrospective analysis assesses the toxicity profile of different radiation techniques (Tomotherapy versus conventional radiotherapy technique) and estimates survival rates. Radiotherapy via Tomotherapy seems to be an efficacious treatment for patients with lower rates of acute upper gastrointestinal and central nervous system toxicities than conventional radiotherapy techniques.Objectives: Recent trials with craniospinal irradiation (CSI) via helical Tomotherapy (HT) demonstrated encouraging medulloblastoma results. In this study, we assess the toxicity profile of different radiation techniques and estimate survival rates. Materials and Methods: We reviewed the records of 46 patients who underwent irradiation for medulloblastoma between 1999 and 2019 (27 conventional radiotherapy technique (CRT) and 19 HT). Patient, tumor, and treatment characteristics, as well as treatment outcomes—local control rate (LCR), event-free survival (EFS), and overall survival (OS)—were reviewed. Acute and late adverse events (AEs) were evaluated according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results: In total, 43 courses of CSI and three local RT were administered to the 46 patients: 30 were male, the median age was 7 years (range 1–56). A median total RT dose of 55 Gy (range 44–68) and a median CSI dose of 35 Gy (range, 23.4–40) was delivered. During follow-up (median, 99 months), six patients (13%) developed recurrence. The EFS rate after 5 years was 84%. The overall OS rates after 5 and 10 years were 95% and 88%, respectively. There were no treatment-related deaths. Following HT, a trend towards lower grade 2/3 acute upper gastrointestinal (p = 0.07) and subacute CNS (p = 0.05) toxicity rates was detected compared to CRT-group. The risk of late CNS toxicities, mainly grade 2/3, was significantly lower following HT technique (p = 0.003). Conclusion: CSI via HT is an efficacious treatment modality in medulloblastoma patients. In all, we detected a reduced rate of several acute, subacute, and chronic toxicities following HT compared to CRT.
Highlights
Medulloblastoma (MB) is a malignant, embryonal solid tumor in the cerebellum
These high survival rates highlight the importance of long-term treatment-related sequelae that significantly impact the patient’s quality of life
Most of the patients were treated according to the German HIT trials for medulloblastoma (HIT2000 trial n = 31, 67%)
Summary
Medulloblastoma (MB) is a malignant, embryonal solid tumor in the cerebellum This neuroectodermal cancer is one of the most common pediatric brain tumors as it represents 10–20% of all central nervous system (CNS) neoplasms in children [1,2]. It can occur at any age, with an incidence peak between 3 and 7 years of age [3]. The 5-year survival rates range from 30% up to 90% [4,5,6,7,8,9,10,11] These high survival rates highlight the importance of long-term treatment-related sequelae that significantly impact the patient’s quality of life. It is crucial to minimize any undesirable toxicities of medulloblastoma therapy [12]
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