MEDB-49. Relapsed SHH medulloblastomas in young children. Are there alternatives to full-dose craniospinal irradiation?

Autor: Craig Erker, Brandon Craig, Simon Bailey, Maura Massimino, Valerie Larouche, Jonathan L Finlay, Cassie Kline, George Michaiel, Ashley Margol, Kenneth Cohen, Chantel Cacciotti, Virginia Harrods, Kathleen Doris, Mohammed AbdelBaki, Nisreen Amayiri, Zhihong Wang, Jordan Hansford, Juliette Hukin, Ralph Salloum, Lindsay Hoffman, Jeffrey Muray, Kevin Ginn, Zapotocky Zapotocky, Lorena Baroni, Vijay Ramaswamy, Stephen Gilheens, Dolli Aguiera, Claire Mazewski, Shafqat Shah, Douglas Strother, Sabine Muller, Amar Gajjar, Paul Northcott, Steve Clifford, Giles Robinson, Eric Bouffet, Lucie Lafay-Cousin
Rok vydání: 2022
Předmět:
Zdroj: Neuro-Oncology. 24:i117-i117
ISSN: 1523-5866
1522-8517
Popis: BACKGROUND/RATIONAL: Following initial irradiation sparing therapy, many young children with relapsed medulloblastoma can be salvaged with craniospinal irradiation (CSI). However, the interval to relapse is short and neurocognitive sequelae remain a major concern. The contribution of molecular subgrouping may help refine indications and modalities of salvage strategies in this population. METHOD: From a cohort of 151 young children with molecularly characterized relapsed medulloblastoma, subset analysis of the SHH medulloblastoma was conducted to describe the practice of salvage radiotherapy and associated post-relapse survival (PRS). RESULTS: Sixty-seven SHH medulloblastoma patients (46 M0; 54 GTR; 11 non-ND/MBEN) received salvage therapy with curative intent. Before relapse, 54 (80.6%) received conventional chemotherapy (CC), 13 (19.4%) high-dose chemotherapy (HDC), while seven had additional focal radiotherapy (fRT). Median time to relapse was 11.1 months (range 3.8-41.0) and 43.3% were localized. Thirty patients (16 localized relapse) underwent surgery. Forty-seven (71.2%) received salvage radiotherapy (20 with CC; 10 with HDC; 15 alone, two unknown). CSI and fRT accounted for 82% and 18% respectively. CSI median dose was 36Gy (range 18-39Gy). Ten patients (eight with localized relapse) received CSI doses ≤23.4Gy. Nineteen patients (28.8%) did not receive any radiotherapy (nine HDC; 10 CC only). Radiotherapy was associated with better 3-year PRS (73.0% versus 36.1%; p=0.001). All patients treated with CSI ≤ 23.4Gy were alive at median follow-up of 69 months(24-142). Six of nine patients treated with HDC without irradiation were alive at last follow-up. Sixty-three percent of patients received reduced dose CSI(≤23.4Gy), fRT, or no radiotherapy, and their PRS did not significantly differ from those who received CSI ≥ 30.6Gy (p = 0.54). CONCLUSION: While salvage CSI provided PRS benefit in this SHH medulloblastoma cohort, we report the use of reduced salvage radiotherapy and irradiation avoidance in 63% of the patients, with 60% alive at last follow-up.
Databáze: OpenAIRE
Externí odkaz: