Synapse - Outcomes of intraventricular 131-I-omburtamab and external beam radiotherapy in patients with recurrent medulloblastoma and ependymoma

Outcomes of intraventricular 131-I-omburtamab and external beam radiotherapy in patients with recurrent medulloblastoma and ependymoma Journal Article

Authors:	Tringale, K. R.; Wolden, S. L.; Karajannis, M.; Haque, S.; Pasquini, L.; Yildirim, O.; Rosenblum, M.; Benhamida, J. K.; Cheung, N. K.; Souweidane, M.; Basu, E. M.; Pandit-Taskar, N.; Zanzonico, P. B.; Humm, J. L.; Kramer, K.
Article Title:	Outcomes of intraventricular 131-I-omburtamab and external beam radiotherapy in patients with recurrent medulloblastoma and ependymoma
Abstract:	Purpose: Intraventricular compartmental radioimmunotherapy (cRIT) with 131-I-omburtamab is a potential therapy for recurrent primary brain tumors that can seed the thecal space. These patients often previously received external beam radiotherapy (EBRT) to a portion or full craniospinal axis (CSI) as part of upfront therapy. Little is known regarding outcomes after re-irradiation as part of multimodality therapy including cRIT. This study evaluates predictors of response, patterns of failure, and radiologic events after cRIT. Methods: Patients with recurrent medulloblastoma or ependymoma who received 131-I-omburtamab on a prospective clinical trial were included. Extent of disease at cRIT initiation (no evidence of disease [NED] vs measurable disease [MD]) was assessed as associated with progression-free (PFS) and overall survival (OS) by Kaplan–Meier analysis. Results: All 27 patients (20 medulloblastoma, 7 ependymoma) had EBRT preceding cRIT: most (22, 81%) included CSI (median dose 2340 cGy, boost to 5400 cGy). Twelve (44%) also received EBRT at relapse as bridging to cRIT. There were no cases of radionecrosis. At cRIT initiation, 11 (55%) medulloblastoma and 3 (43%) ependymoma patients were NED, associated with improved PFS (p = 0.002) and OS (p = 0.048) in medulloblastoma. Most relapses were multifocal. With medium follow-up of 3.0 years (95% confidence interval, 1.8–7.4), 6 patients remain alive with NED. Conclusion: For patients with medulloblastoma, remission at time of cRIT was associated with significantly improved survival outcomes. Relapses are often multifocal, particularly in the setting of measurable disease at cRIT initiation. EBRT is a promising tool to achieve NED status at cRIT initiation, with no cases of radiation necrosis. © 2023, The Author(s).
Keywords:	brain tumor; brain neoplasms; prospective study; prospective studies; neoplasm recurrence, local; radiotherapy dosage; monoclonal antibody; chronic disease; antibodies, monoclonal; radioactive iodine; iodine radioisotopes; tumor recurrence; medulloblastoma; ependymoma; external beam radiotherapy; cerebellar neoplasms; pediatric brain tumors; radiation necrosis; cerebellum tumor; humans; human; proton beam radiotherapy; intraventricular compartmental radioimmunotherapy
Journal Title:	Journal of Neuro-Oncology
Volume:	162
Issue:	1
ISSN:	0167-594X
Publisher:	Springer
Date Published:	2023-03-01
Start Page:	69
End Page:	78
Language:	English
DOI:	10.1007/s11060-022-04235-w
PUBMED:	36853490
PROVIDER:	scopus
PMCID:	PMC10050019
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85149007138&doi=10.1007%2fs11060-022-04235-w&partnerID=40&md5=dcb61ac27a6adcb9f1243277f8b45213
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Kim Kramer -- Source: Scopus