Patterns of failure using a conformal radiation therapy tumor bed boost for medulloblastoma Journal Article

Authors: Wolden, S. L.; Dunkel, I. J.; Souweidane, M. M.; Happersett, L.; Khakoo, Y.; Schupak, K.; Lyden, D.; Leibel, S. A.
Article Title: Patterns of failure using a conformal radiation therapy tumor bed boost for medulloblastoma
Abstract: Purpose: To assess the patterns of failure for patients with medulloblastoma receiving a conformal tumor bed boost rather than a boost to the entire posterior fossa. Patients and Methods: From 1994 to 2002, 32 consecutive patients with newly diagnosed medulloblastoma treated at Memorial Sloan-Kettering Cancer Center (New York, NY) received a conformal boost to the tumor bed in conjunction with craniospinal radiation therapy. Twenty-eight patients also received chemotherapy. The median age was 9 years (range, 3 to 34 years), and the male to female ratio was 3:1. Twenty-seven patients had standard-risk disease, and five patients had high-risk disease. Craniospinal doses ranged from 23.4 to 39.6 Gy, and total tumor bed doses ranged from 54 to 59.4 Gy. Results: With a median follow-up of 56 months, six patients have relapsed; five relapsed outside of the posterior fossa, and one failed within the posterior fossa, outside of the high-dose boost volume. Five-year actuarial disease-free and overall survival rates were 84% and 85%, respectively. Freedom from posterior fossa failure was 100% and 86% at 5 and 10 years, respectively. Freedom from distant failure was 84% at 5 years, with a trend for improvement when full-dose craniospinal radiation (36 to 39.6 Gy) was used compared with a reduced dose (23.4 Gy) of radiation (100% v 63%, respectively; P = .06). No other predictive variables were identified. Conclusion: Conformal treatment to the tumor bed allows for significant sparing of critical structures. The posterior fossa failure rate in this series is similar to that reported when the entire posterior fossa is treated. This approach should be investigated further in a phase III trial. © 2003 by American Society of Clinical Oncology.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; child; clinical article; controlled study; preschool child; child, preschool; disease-free survival; treatment failure; overall survival; multimodality cancer therapy; cancer radiotherapy; disease free survival; radiation dose; combined modality therapy; brain tumor; methodology; brain neoplasms; antineoplastic agent; carboplatin; antineoplastic combined chemotherapy protocols; radiotherapy dosage; vincristine; medulloblastoma; radiotherapy, conformal; computer assisted radiotherapy; radiation dose distribution; posterior fossa; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 21
Issue: 16
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2003-08-15
Start Page: 3079
End Page: 3083
Language: English
DOI: 10.1200/jco.2003.11.140
PUBMED: 12915597
PROVIDER: scopus
Notes: Export Date: 12 September 2014 -- Source: Scopus
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MSK Authors
  1. Ira J Dunkel
    251 Dunkel
  2. David C Lyden
    83 Lyden
  3. Yasmin Khakoo
    99 Khakoo
  4. Suzanne L Wolden
    419 Wolden
  5. Steven A Leibel
    215 Leibel
  6. Karen D Schupak
    67 Schupak