Low incidence of radionecrosis in children treated with conventional radiation therapy and intrathecal radioimmunotherapy Journal Article


Authors: Kramer, K.; Pandit-Taskar, N.; Zanzonico, P.; Wolden, S. L.; Humm, J. L.; Deselm, C.; Souweidane, M. M.; Lewis, J. S.; Cheung, N. K. V.
Article Title: Low incidence of radionecrosis in children treated with conventional radiation therapy and intrathecal radioimmunotherapy
Abstract: Radionecrosis is a potentially devastating complication of external beam radiotherapy (XRT). Intraventricular compartmental radioimmunotherapy (cRIT) using 131I-3F8 or 131I-8H9 can eradicate malignant cells in the CSF. The incidence of radionecrosis using cRIT 131I based intraventricular radioimmunotherapy, when used alone or in combination with conventional craniospinal CSI-XRT is unknown. We retrospectively analyzed the incidence of radionecrosis in two cohorts of pediatric patients treated with both CSI-XRT and cRIT at MSKCC since 2003: patients with metastatic CNS neuroblastoma (NB) and medulloblastoma (MB). 94 patients received both CSI-XRT and cRIT, two received cRIT alone, median follow up 41.5 months (6.5–124.8 months). Mean CSI-XRT dose was 28 Gy (boost to the primary tumor site up to 54 Gy) in the MB cohort, and CSI XRT dose 18–21 Gy (boost to 30 Gy for focal parenchymal mass) in the NB cohort. For MB patients, 20 % had focal re-irradiation for a second or more subsequent relapse, mean repeat-XRT dose was 27.5 Gy; seven patients with NB had additional focal XRT. Median CSF cRIT dose was 18.6 Gy in the MB cohort and 32.1 in the NB cohort. One asymptomatic patient underwent resection of 0.6-cm hemorrhagic periventricular white-matter lesion confirmed to be necrosis and granulation tissue, 2.5 years after XRT. The risk of radionecrosis in children treated with XRT and cRIT appears minimal (~1 %). No neurologic deficits secondary to radionecrosis have been observed in long-term survivors treated with both modalities, including patients who underwent re-XRT. Administration of cRIT may safely proceed in patients treated with conventional radiotherapy without appearing to increase the risk of radionecrosis. © 2015, Springer Science+Business Media New York.
Keywords: adolescent; adult; child; controlled study; unclassified drug; major clinical study; cancer recurrence; radiation dose; outcome assessment; follow up; neurosurgery; cohort analysis; retrospective study; cancer survivor; risk assessment; monoclonal antibody; drug dose escalation; cancer regression; whole body radiation; infant; neuroblastoma; dosimetry; medulloblastoma; patient safety; radiation therapy; external beam radiotherapy; radioimmunotherapy; neurologic disease; radiation necrosis; pediatric oncology; monoclonal antibody 3f8 i 131; brain tumors; granulation tissue; autologous bone marrow transplantation; clinical trial (topic); partial body radiation; monoclonal antibody 8h9 i 131; side effects; radiation absorption; long term survival; white matter lesion; human; male; female; article; intrathecal therapy; craniospinal radiation therapy
Journal Title: Journal of Neuro-Oncology
Volume: 123
Issue: 2
ISSN: 0167-594X
Publisher: Springer  
Date Published: 2015-06-01
Start Page: 245
End Page: 249
Language: English
DOI: 10.1007/s11060-015-1788-z
PROVIDER: scopus
PUBMED: 25944385
PMCID: PMC4955595
DOI/URL:
Notes: Export Date: 2 July 2015 -- Source: Scopus
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MSK Authors
  1. Nai-Kong Cheung
    447 Cheung
  2. Kim Kramer
    170 Kramer
  3. Suzanne L Wolden
    424 Wolden
  4. John Laurence Humm
    342 Humm
  5. Pat B Zanzonico
    246 Zanzonico
  6. Jason S Lewis
    245 Lewis
  7. Carl J Deselm
    15 Deselm