Late toxicity following craniospinal radiation for early-stage medulloblastoma

Authors

  • Kaitlin M. Christopherson Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
  • Ronny L. Rotondo University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
  • Julie A. Bradley University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
  • David W. Pincus Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  • Tung T. Wynn Department of Hematology University of Florida, Gainesville, Florida, USA
  • John A. Fort Department of Hematology University of Florida, Gainesville, Florida, USA
  • Christopher G. Morris Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
  • Nancy P. Mendenhall University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
  • Robert B. Marcus Jr. University of Florida Proton Therapy Institute, Jacksonville, Florida, USA
  • Daniel J. Indelicato University of Florida Proton Therapy Institute, Jacksonville, Florida, USA

DOI:

https://doi.org/10.3109/0284186X.2013.862596

Abstract

Background. The purpose of this study is to review late toxicity following craniospinal radiation for early-stage medulloblastoma.

Material and methods. Between 1963 and 2008, 53 children with stage M0 (n = 50) or M1 (n = 3) medulloblastoma were treated at our institution. The median age at diagnosis was 7.1 years (range 1.2–18.5). The median craniospinal irradiation (CSI) dose was 28.8 Gy (range 21.8–38.4). The median total dose, including boost, was 54 Gy (range 42.4–64.8 Gy). Since 1963, the CSI dose has been incrementally lowered and the high-risk boost volume reduced. Twenty-one patients (40%) received chemotherapy in their initial management, including 12 who received concurrent chemotherapy. Late sequelae were evaluated by analyzing medical records and conducting phone interviews with surviving patients and/or care-takers. Complications were graded using the NCI Common Terminology Criteria for Adverse Events, version 4.0.

Results. The median follow-up for all patients was 15.4 years (range 0.4–44.4) and for living patients it was 24 years (range 5.6–44.4). The overall survival, cause-specific survival, and progression-free survival rates at 10 years were 67%, 67%, and 71%, respectively. Sixteen patients (41% of patients who survived five years or more) developed grade 3 + toxicity; 15 of these 16 patients received a CSI dose > 23.4 Gy. The most common grade 3 + toxicities for long-term survivors are hearing impairment requiring intervention (20.5%) and cognitive impairment (18%) prohibiting independent living. Four patients developed secondary (non-skin) malignancies, including three meningiomas, one rhabdomyosarcoma, and one glioblastoma multiforme. Three patients (5.6%) died from treatment complications, including radionecrosis, severe cerebral edema, and fatal secondary malignancy.

Conclusion. Ongoing institutional and cooperative group efforts to minimize radiation exposure are justified given the high rate of serious toxicity observed in our long-term survivors. Follow-up through long-term multidisciplinary clinics is important and warranted for all patients exposed to radiotherapy in childhood.

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Published

2014-04-01

How to Cite

Christopherson, K. M., Rotondo, R. L., Bradley, J. A., Pincus, D. W., Wynn, T. T., Fort, J. A., … Indelicato, D. J. (2014). Late toxicity following craniospinal radiation for early-stage medulloblastoma. Acta Oncologica, 53(4), 471–480. https://doi.org/10.3109/0284186X.2013.862596

Issue

Vol. 53 No. 4 (2014): Acta Oncologica

Section

Articles