Disease control and ototoxicity using intensity-modulated radiation therapy tumor-bed boost for medulloblastoma Journal Article
| Authors: | Polkinghorn, W. R.; Dunkel, I. J.; Souweidane, M. M.; Khakoo, Y.; Lyden, D. C.; Gilheeney, S. W.; Becher, O. J.; Budnick, A. S.; Wolden, S. L. |
| Article Title: | Disease control and ototoxicity using intensity-modulated radiation therapy tumor-bed boost for medulloblastoma |
| Abstract: | Purpose: We previously reported excellent local control for treating medulloblastoma with a limited boost to the tumor bed. In order to decrease ototoxicity, we subsequently implemented a tumor-bed boost using intensity-modulated radiation therapy (IMRT), the clinical results of which we report here. Patients and Methods: A total of 33 patients with newly diagnosed medulloblastoma, 25 with standard risk, and 8 with high risk, were treated on an IMRT tumor-bed boost following craniospinal irradiation (CSI). Six standard-risk patients were treated with an institutional protocol with 18 Gy CSI in conjunction with intrathecal iodine-131-labeled monoclonal antibody. The majority of patients received concurrent vincristine and standard adjuvant chemotherapy. Pure-tone audiograms were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: Median age was 9 years old (range, 4-46 years old). Median follow-up was 63 months. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) rates for standard-risk patients who received 23.4 or 36 Gy CSI (not including those who received 18 Gy CSI with radioimmunotherapy) were 81.4% and 88.4%, respectively, at 5 years; 5-year PFS and OS rates for high-risk patients were both 87.5%. There were no isolated posterior fossa failures outside of the boost volume. Posttreatment audiograms were available for 31 patients, of whom 6%, at a median follow-up of 19 months, had developed Grade 3 hearing loss. Conclusion: An IMRT tumor-bed boost results in excellent local control while delivering a low mean dose to the cochlea, resulting in a low rate of ototoxicity. © 2011 Elsevier Inc. |
| Keywords: | adolescent; adult; cancer survival; child; clinical article; preschool child; school child; child, preschool; disease-free survival; middle aged; retrospective studies; young adult; intensity modulated radiation therapy; cisplatin; cancer risk; radiation dose; chemotherapy, adjuvant; chemotherapy; follow up; follow-up studies; progression free survival; multiple cycle treatment; tumor volume; radiotherapy dosage; radiotherapy; vincristine; lomustine; cranial irradiation; monoclonal antibodies; antibodies, monoclonal; iodine 131; iodine radioisotopes; brain; imrt; physical therapy; tumors; radiotherapy, intensity-modulated; adjuvant chemotherapy; medulloblastoma; new york city; local control; hearing; tumor growth; cancer control; disease control; radioimmunotherapy; cerebellar neoplasms; mannitol; hearing loss; standards; ototoxicity; overall survival rates; iodine; post treatment; posterior fossa; mean dose; audition; cochlea; craniospinal irradiation; intrathecal; adverse events; tumor bed; common terminology criteria; national cancer institute; low rates; high-risk patients; kaplan-meier estimates; pure tone audiometry; tumor-bed boost |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 81 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2011-11-01 |
| Start Page: | e15 |
| End Page: | e20 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2010.11.081 |
| PUBMED: | 21481547 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - Presented at the 50th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Boston, MA, Sep 21-24, 2008 - "Cited By (since 1996): 4" - "Export Date: 5 June 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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MSK Authors
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371Dunkel -
87Lyden -
149Khakoo -
560Wolden -
219Souweidane -
24Polkinghorn -
19Budnick -
25Becher -
78Gilheeney
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