Outcomes of salvage re-irradiation in recurrent medulloblastoma correlate with age at initial diagnosis, primary risk-stratification, and molecular subgrouping

AbstractPurposeTo report outcomes of salvage re-irradiation (re-RT) in recurrent/progressive medulloblastoma (MB).MethodsMedical records of patients treated with curative-intent re-RT as multi-modality management for recurrent/progressive MB between 2008 and 2018 were analyzed retrospectively.ResultsA total of 28 patients (median age 18  years at index diagnosis) were included. Molecular subgrouping was done using real-time reverse transcriptase polymerase chain reaction (RT-PCR) based on the differential expression of select set of 12 protein coding genes and 9 microRNAs. Fifteen of 17 (88%) patients with sonic hedgehog (SHH)-MB developed isolated local recurrence within the index tumor-bed, while 5 of 7 (72%) patients with Group 4 MB developed localized relapse outside the posterior fossa. Diffuse neuraxial dissemination was seen in 2 patients with SHH-MB, and one each of Group 4 and wingless (WNT)-MB. Molecular subgroupi ng was not known in 3 patients. The dose and volume of re-RT was based on site and patterns of relapse, comprising unifocal in 18 (64%), multi-focal in 3 (11%), and repeat craniospinal irradiation (re-CSI) in 7 (25%) patients. Median interval from primary irradiation to re-RT was 49.5 months (range 24–98 months) with median cumulative biologically effective dose of 117 Gy (range 78–132 Gy). All patients received platinum-based salvage chemotherapy either before or after re-RT. One patient developed symptomatic radi...
Source: Journal of Neuro-Oncology - Category: Cancer & Oncology Source Type: research

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Conditions:   Glioblastoma;   Medulloblastoma;   Ependymoma;   Diffuse Intrinsic Pontine Glioma Interventions:   Drug: Indoximod;   Radiation: Partial Radiation;   Radiation: Full-dose Radiation;   Drug: Temozolomide;   Drug: Cyclophosphamide;   Drug: Etoposide;   Drug: Lomustine Sponsors:   Theodore S. Johnson;   Emory University Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Journal of Medicinal ChemistryDOI: 10.1021/acs.jmedchem.9b00851
Source: Journal of Medicinal Chemistry - Category: Chemistry Authors: Source Type: research
This study aims to evaluate the outcome of HDC/auto-SCT with topotecan –thiotepa–carboplatin and melphalan–etoposide–carboplatin (TTC/MEC) regimens in pediatric brain tumors.MethodsWe retrospectively analyzed the data of 33 children (median age 6  years) who underwent HDC/auto-SCT (18 tandem and 15 single) with uniform conditioning regimens.ResultsEleven patients aged  
Source: International Journal of Clinical Oncology - Category: Cancer & Oncology Source Type: research
Abstract PUPOSE: Medulloblastoma is the most common primary malignant central nervous system tumor in childhood, accounting for 16-25% of cases (1). New treatment approaches have led to improved survival rates; however toxicities are still a major concern. PATIENTS AND METHODS: Participants were selected from the records of patients who were treated with craniospinal irradiation for medulloblastoma. Between January 2008 and December 2012, 62 patients were diagnosed with medulloblastoma at the national institute of oncology Rabat, 27 patients were still alive at the time of the study, of which n=16 patients we...
Source: Cancer Radiotherapie - Category: Cancer & Oncology Authors: Tags: Cancer Radiother Source Type: research
Opinion statementMedulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa and is the most common type of brain cancer in pediatric patients. In contrast, adult MB is very rare with an incidence of 0.6 per million per year and mostly affects young adults below the age of 40. Recent molecular analyses of pediatric and adult MB have classified these tumors into at least four individual molecular subgroups (SHH, WNT, group 3, and group 4) with distinct demographics, histology, and prognosis. The discrete biological composition of these tumors likely explains the marked heterogeneity in responses seen to conve...
Source: Current Treatment Options in Oncology - Category: Cancer & Oncology Source Type: research
Abstract Medulloblastoma is the most common malignant brain tumors in children. Current management combine surgery, radiotherapy, and chemotherapy. Current treatment of medulloblastoma is based on a clinical risk-stratification system that takes into account age, extent of resection and metastatic status. High risk medulloblastoma patients are defined by the presence of metastatic disease and/or an incomplete resection with a residual amount of tumour> 1.5 cm2. This review describes the evolution in the management of high risk medulloblastoma patients during recent 4 decades and recent changes in the definition...
Source: Neuro-Chirurgie - Category: Neurosurgery Authors: Tags: Neurochirurgie Source Type: research
ConclusionsA proper multidisciplinary management of pineoblastomas, which associates gross total microsurgical resection of the lesion and an adjuvant therapy determined by our neurooncology team based on accurate craniospinal adjuvant radiotherapy with boost of radiation on the tumoral bed, and when needed, an adequate but aggressive medulloblastoma-like chemotherapy, may improve the overall survival of these malignant lesions.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
CONCLUSION: Overall, our results are comparable to those reported in literature. Nevertheless, efforts should be made to ensure longer follow-ups and correctly assess treatment-related toxicity. PMID: 31109839 [PubMed - as supplied by publisher]
Source: Cancer Radiotherapie - Category: Cancer & Oncology Authors: Tags: Cancer Radiother Source Type: research
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