Patterns of failure following multimodal treatment for medulloblastoma

Long-term follow-up results at a single institution

Dong Soo Lee, Jaeho Cho, SeHoon Kim, Dong Seok Kim, Kyu Won Shim, Chuhl Joo Lyu, Jung Woo Han, Chang-Ok Suh

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose The purpose of this study is to investigate the long-term results and appropriateness of radiation therapy (RT) for medulloblastoma (MB) at a single institution. Materials and Methods We analyzed the clinical outcomes of 106 patients with MB who received RT between January 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), and the 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 in 102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. Results The median follow-up period in survivors was 132 months (range, 31 to 248 months). A gradual improvement in survival outcomes was observed, with 5-year overall survival rates of 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developed at the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossa other than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinal subarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Although the frequency of posterior fossa/tumor bed recurrences was significantly high among patients treated with subtotal resection, other site (other intracranial/spinal) recurrences were more common among patients treated with gross tumor removal (p=0.016). There was no case of spinal subarachnoid space relapse from desmoplastic/extensive nodular histological subtypes. Conclusion Long-term follow-up results and patterns of failure confirmed the importance of optimal RT dose and field arrangement. More tailored multimodal strategies and proper CSI technique may be the cornerstones for improving treatment outcomes in MB patients.

Original languageEnglish
Pages (from-to)879-888
Number of pages10
JournalCancer Research and Treatment
Volume47
Issue number4
DOIs
Publication statusPublished - 2015 Jan 1

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Combined Modality Therapy
Medulloblastoma
Craniospinal Irradiation
Infratentorial Neoplasms
Recurrence
Subarachnoid Space
Radiotherapy
Survivors
Neoplasms
Survival Rate
Survival

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

@article{e84d6806b05140f7b514fe705fdd8118,
title = "Patterns of failure following multimodal treatment for medulloblastoma: Long-term follow-up results at a single institution",
abstract = "Purpose The purpose of this study is to investigate the long-term results and appropriateness of radiation therapy (RT) for medulloblastoma (MB) at a single institution. Materials and Methods We analyzed the clinical outcomes of 106 patients with MB who received RT between January 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), and the 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 in 102 patients (96.2{\%}) treated with CSI was 36 Gy and 54 Gy, respectively. Results The median follow-up period in survivors was 132 months (range, 31 to 248 months). A gradual improvement in survival outcomes was observed, with 5-year overall survival rates of 61.5{\%} in 1990s increasing to 73.6{\%} in 2000s. A total of 29 recurrences (27.4{\%}) developed at the following sites: five (17.2{\%}) in the tumor bed; five (17.2{\%}) in the posterior fossa other than the tumor bed; nine (31{\%}) in the supratentorium; and six (20.7{\%}) in the spinal subarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Although the frequency of posterior fossa/tumor bed recurrences was significantly high among patients treated with subtotal resection, other site (other intracranial/spinal) recurrences were more common among patients treated with gross tumor removal (p=0.016). There was no case of spinal subarachnoid space relapse from desmoplastic/extensive nodular histological subtypes. Conclusion Long-term follow-up results and patterns of failure confirmed the importance of optimal RT dose and field arrangement. More tailored multimodal strategies and proper CSI technique may be the cornerstones for improving treatment outcomes in MB patients.",
author = "Lee, {Dong Soo} and Jaeho Cho and SeHoon Kim and Kim, {Dong Seok} and Shim, {Kyu Won} and Lyu, {Chuhl Joo} and Han, {Jung Woo} and Chang-Ok Suh",
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Patterns of failure following multimodal treatment for medulloblastoma : Long-term follow-up results at a single institution. / Lee, Dong Soo; Cho, Jaeho; Kim, SeHoon; Kim, Dong Seok; Shim, Kyu Won; Lyu, Chuhl Joo; Han, Jung Woo; Suh, Chang-Ok.

In: Cancer Research and Treatment, Vol. 47, No. 4, 01.01.2015, p. 879-888.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Patterns of failure following multimodal treatment for medulloblastoma

T2 - Long-term follow-up results at a single institution

AU - Lee, Dong Soo

AU - Cho, Jaeho

AU - Kim, SeHoon

AU - Kim, Dong Seok

AU - Shim, Kyu Won

AU - Lyu, Chuhl Joo

AU - Han, Jung Woo

AU - Suh, Chang-Ok

PY - 2015/1/1

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N2 - Purpose The purpose of this study is to investigate the long-term results and appropriateness of radiation therapy (RT) for medulloblastoma (MB) at a single institution. Materials and Methods We analyzed the clinical outcomes of 106 patients with MB who received RT between January 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), and the 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 in 102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. Results The median follow-up period in survivors was 132 months (range, 31 to 248 months). A gradual improvement in survival outcomes was observed, with 5-year overall survival rates of 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developed at the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossa other than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinal subarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Although the frequency of posterior fossa/tumor bed recurrences was significantly high among patients treated with subtotal resection, other site (other intracranial/spinal) recurrences were more common among patients treated with gross tumor removal (p=0.016). There was no case of spinal subarachnoid space relapse from desmoplastic/extensive nodular histological subtypes. Conclusion Long-term follow-up results and patterns of failure confirmed the importance of optimal RT dose and field arrangement. More tailored multimodal strategies and proper CSI technique may be the cornerstones for improving treatment outcomes in MB patients.

AB - Purpose The purpose of this study is to investigate the long-term results and appropriateness of radiation therapy (RT) for medulloblastoma (MB) at a single institution. Materials and Methods We analyzed the clinical outcomes of 106 patients with MB who received RT between January 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), and the 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 in 102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. Results The median follow-up period in survivors was 132 months (range, 31 to 248 months). A gradual improvement in survival outcomes was observed, with 5-year overall survival rates of 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developed at the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossa other than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinal subarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Although the frequency of posterior fossa/tumor bed recurrences was significantly high among patients treated with subtotal resection, other site (other intracranial/spinal) recurrences were more common among patients treated with gross tumor removal (p=0.016). There was no case of spinal subarachnoid space relapse from desmoplastic/extensive nodular histological subtypes. Conclusion Long-term follow-up results and patterns of failure confirmed the importance of optimal RT dose and field arrangement. More tailored multimodal strategies and proper CSI technique may be the cornerstones for improving treatment outcomes in MB patients.

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