Patterns of Failure Following Multimodal Treatment for Medulloblastoma: Long-Term Follow-up Results at a Single Institution
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Purpose The purpose of this study is to investigate the long-term results and appropriateness ofradiation therapy (RT) for medulloblastoma (MB) at a single institution. Materials and MethodsWe analyzed the clinical outcomes of 106 patients with MB who received RT betweenJanuary 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), andthe proportion of M0, M1, M2, and M3 stages was 60.4%, 8.5%, 4.7%, and 22.6%, respectively. The median total craniospinal irradiation (CSI) and posterior fossa tumor bed dose in102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. ResultsThe median follow-up period in survivors was 132 months (range, 31 to 248 months). Agradual improvement in survival outcomes was observed, with 5-year overall survival ratesof 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developedat the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossaother than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinalsubarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Althoughthe frequency of posterior fossa/tumor bed recurrences was significantly high amongpatients treated with subtotal resection, other site (other intracranial/spinal) recurrenceswere more common among patients treated with gross tumor removal (p=0.016). Therewas no case of spinal subarachnoid space relapse from desmoplastic/extensive nodularhistological subtypes. ConclusionLong-term follow-up results and patterns of failure confirmed the importance of optimal RTdose and field arrangement. More tailored multimodal strategies and proper CSI techniquemay be the cornerstones for improving treatment outcomes in MB patients.
Abstract
Purpose The purpose of this study is to investigate the long-term results and appropriateness ofradiation therapy (RT) for medulloblastoma (MB) at a single institution. Materials and MethodsWe analyzed the clinical outcomes of 106 patients with MB who received RT betweenJanuary 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), andthe proportion of M0, M1, M2, and M3 stages was 60.4%, 8.5%, 4.7%, and 22.6%, respectively. The median total craniospinal irradiation (CSI) and posterior fossa tumor bed dose in102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. ResultsThe median follow-up period in survivors was 132 months (range, 31 to 248 months). Agradual improvement in survival outcomes was observed, with 5-year overall survival ratesof 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developedat the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossaother than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinalsubarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Althoughthe frequency of posterior fossa/tumor bed recurrences was significantly high amongpatients treated with subtotal resection, other site (other intracranial/spinal) recurrenceswere more common among patients treated with gross tumor removal (p=0.016). Therewas no case of spinal subarachnoid space relapse from desmoplastic/extensive nodularhistological subtypes. ConclusionLong-term follow-up results and patterns of failure confirmed the importance of optimal RTdose and field arrangement. More tailored multimodal strategies and proper CSI techniquemay be the cornerstones for improving treatment outcomes in MB patients.
참고문헌 (16)
- Bloom HJ, "The treatment and prognosis of medulloblastoma in children : a study of 82 verified cases", Am J Roentgenol Radium Ther Nucl Med, 105, pp.43~62 (1969)
- Sun Young Kim, "Reduced-dose craniospinal radiotherapy followed by high-dose chemotherapy and autologous stem cell rescue for children with newly diagnosed high-risk medulloblastoma or supratentorial primitive neuroectodermal tumor", Blood Research, 45(2), pp.120~126 (2010), 대한혈액학회
- Paulino AC, "Local control after craniospinal irradiation, intensitymodulated radiotherapy boost, and chemotherapy in childhood medulloblastoma", Cancer, 117, pp.635~641 (2011)
- de Haas T, "Molecular risk stratification of medulloblastoma patients based on immunohistochemical analysis of MYC, LDHB, and CCNB1 expression", Clin Cancer Res, 14, pp.4154~4160 (2008)
- Taylor MD, "Molecular subgroups of medulloblastoma : the current consensus", Acta Neuropathol, 123, pp.465~472 (2012)
- 이석, "전산화단층촬영모의치료장치를 이용한 배와위 두개척수 방사선치료 계획", Radiation oncology journal, 20(2), pp.10~171 (2002), 대한방사선종양학회
- Sun LM, "Postoperative radiation therapy for medulloblastoma : high recurrence rate in the subfrontal region", J Neurooncol, 58, pp.77~85 (2002)
- 조재호, "수모세포종의 방사선치료 후 전두엽하방재발된 환자에서 원인 분석 및 구제 치료", Radiation oncology journal, 22(3), pp.165~176 (2004), 대한방사선종양학회
- Rieken S, "Outcome and prognostic factors of desmoplastic medulloblastoma treated within a multidisciplinary treatment concept", BMC Cancer, 10, pp.450~ (2010)
- Tarbell NJ, "The change in patterns of relapse in medulloblastoma", Cancer, 68, pp.1600~1604 (1991)
- Packer RJ, "Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy : a Children's Cancer Group Study", J Clin Oncol, 17, pp.2127~2136 (1999)
- Packer RJ, "Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma", J Clin Oncol, 24, pp.4202~4208 (2006)
- Gajjar A, "Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma(St Jude Medulloblastoma-96) : long-term results from a prospective, multicentre trial", Lancet Oncol, 7, pp.813~820 (2006)
- Rieken S, "Outcome and prognostic factors of radiation therapy for medulloblastoma", Int J Radiat Oncol Biol Phys, 81, pp.e7~13 (2011)
- Maleci A, "Medulloblastoma in children and in adults : a comparative study", Acta Neurochir(Wien), 119, pp.62~67 (1992)
- Bakst RL, "Reirradiation for recurrent medulloblastoma", Cancer, 117, pp.4977~4982 (2011)