Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review

Avani D. Rao, Arif S. Rashid, Qinyu Chen, Rosangela C. Villar, Daria Kobyzeva, Kristina Nilsson, Karin Dieckmann, Alexey Nechesnyuk, Ralph Ermoian, Sara Alcorn, Shannon M. MacDonald, Matthew Ladra, Eric C. Ford, Brian A. Winey, Maria Luisa S. Figueiredo, Michael J. Chen, Stephanie A Terezakis

Research output: Contribution to journalArticle

Abstract

Purpose Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients. Methods and Materials The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed. Results Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n=20; 30%), ependymoma (n=19; 28%), germ cell tumor (n=8; 12%), high-grade glioma (n=9; 13%), low-grade glioma (n=5; 7%), and other (n=6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n=46), 3-dimensional conformal RT (n=9), stereotactic radiosurgery (n=4; 12-13 Gy × 1 or 5 Gy × 5), protons (n=4), combined modality (n=3), 2-dimensional RT (n=1), and brachytherapy (n=1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively. Conclusions CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.

Original languageEnglish (US)
Pages (from-to)634-641
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume99
Issue number3
DOIs
StatePublished - Nov 1 2017

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central nervous system
radiation therapy
Radiotherapy
Central Nervous System
Pediatrics
Neoplasms
Ependymoma
neoplasms
Medulloblastoma
Re-Irradiation
Glioma
toxicity
grade
tumors
Radiation
Dose Fractionation
Primitive Neuroectodermal Tumors
Recurrence
Survival
Radiosurgery

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Reirradiation for Recurrent Pediatric Central Nervous System Malignancies : A Multi-institutional Review. / Rao, Avani D.; Rashid, Arif S.; Chen, Qinyu; Villar, Rosangela C.; Kobyzeva, Daria; Nilsson, Kristina; Dieckmann, Karin; Nechesnyuk, Alexey; Ermoian, Ralph; Alcorn, Sara; MacDonald, Shannon M.; Ladra, Matthew; Ford, Eric C.; Winey, Brian A.; Figueiredo, Maria Luisa S.; Chen, Michael J.; Terezakis, Stephanie A.

In: International Journal of Radiation Oncology Biology Physics, Vol. 99, No. 3, 01.11.2017, p. 634-641.

Research output: Contribution to journalArticle

Rao, AD, Rashid, AS, Chen, Q, Villar, RC, Kobyzeva, D, Nilsson, K, Dieckmann, K, Nechesnyuk, A, Ermoian, R, Alcorn, S, MacDonald, SM, Ladra, M, Ford, EC, Winey, BA, Figueiredo, MLS, Chen, MJ & Terezakis, SA 2017, 'Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review', International Journal of Radiation Oncology Biology Physics, vol. 99, no. 3, pp. 634-641. https://doi.org/10.1016/j.ijrobp.2017.07.026
Rao, Avani D. ; Rashid, Arif S. ; Chen, Qinyu ; Villar, Rosangela C. ; Kobyzeva, Daria ; Nilsson, Kristina ; Dieckmann, Karin ; Nechesnyuk, Alexey ; Ermoian, Ralph ; Alcorn, Sara ; MacDonald, Shannon M. ; Ladra, Matthew ; Ford, Eric C. ; Winey, Brian A. ; Figueiredo, Maria Luisa S. ; Chen, Michael J. ; Terezakis, Stephanie A. / Reirradiation for Recurrent Pediatric Central Nervous System Malignancies : A Multi-institutional Review. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 99, No. 3. pp. 634-641.
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title = "Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review",
abstract = "Purpose Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients. Methods and Materials The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed. Results Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n=20; 30{\%}), ependymoma (n=19; 28{\%}), germ cell tumor (n=8; 12{\%}), high-grade glioma (n=9; 13{\%}), low-grade glioma (n=5; 7{\%}), and other (n=6; 9{\%}). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78{\%}) and surrounding the initial RT field in 15 patients (22{\%}). Thirty-seven patients (58{\%}) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n=46), 3-dimensional conformal RT (n=9), stereotactic radiosurgery (n=4; 12-13 Gy × 1 or 5 Gy × 5), protons (n=4), combined modality (n=3), 2-dimensional RT (n=1), and brachytherapy (n=1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9{\%}) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively. Conclusions CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.",
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T1 - Reirradiation for Recurrent Pediatric Central Nervous System Malignancies

T2 - A Multi-institutional Review

AU - Rao, Avani D.

AU - Rashid, Arif S.

AU - Chen, Qinyu

AU - Villar, Rosangela C.

AU - Kobyzeva, Daria

AU - Nilsson, Kristina

AU - Dieckmann, Karin

AU - Nechesnyuk, Alexey

AU - Ermoian, Ralph

AU - Alcorn, Sara

AU - MacDonald, Shannon M.

AU - Ladra, Matthew

AU - Ford, Eric C.

AU - Winey, Brian A.

AU - Figueiredo, Maria Luisa S.

AU - Chen, Michael J.

AU - Terezakis, Stephanie A

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Purpose Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients. Methods and Materials The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed. Results Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n=20; 30%), ependymoma (n=19; 28%), germ cell tumor (n=8; 12%), high-grade glioma (n=9; 13%), low-grade glioma (n=5; 7%), and other (n=6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n=46), 3-dimensional conformal RT (n=9), stereotactic radiosurgery (n=4; 12-13 Gy × 1 or 5 Gy × 5), protons (n=4), combined modality (n=3), 2-dimensional RT (n=1), and brachytherapy (n=1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively. Conclusions CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.

AB - Purpose Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients. Methods and Materials The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed. Results Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n=20; 30%), ependymoma (n=19; 28%), germ cell tumor (n=8; 12%), high-grade glioma (n=9; 13%), low-grade glioma (n=5; 7%), and other (n=6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n=46), 3-dimensional conformal RT (n=9), stereotactic radiosurgery (n=4; 12-13 Gy × 1 or 5 Gy × 5), protons (n=4), combined modality (n=3), 2-dimensional RT (n=1), and brachytherapy (n=1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively. Conclusions CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.

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