Patterns of failure using a conformal radiation therapy tumor bed boost for medulloblastoma
Patterns of failure using a conformal radiation therapy tumor bed boost for medulloblastoma
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DOI：
10.1200/jco.2003.11.140
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发表时间：
2003-08-15
影响因子：
45.3
通讯作者：
Leibel, SA
中科院分区：
文献类型：
--
作者：
Wolden, SL;Dunkel, IJ;Leibel, SA
目的：评估髓母细胞瘤患者接受适形肿瘤床推进术而不是整个后颅窝推进术的失败模式。患者和方法：从1994年到2002年，在纽约纪念斯隆-凯特林癌症中心治疗的32例新诊断的髓母细胞瘤患者，在接受颅脊放射治疗的同时，接受了肿瘤床的适形推进术。28名患者也接受了化疗。中位年龄9岁(3~34岁)，男女之比为3：1。27例为标准危险疾病，5例为高危疾病。结果：中位随访期56个月，6例复发，5例后颅窝外复发，1例后颅窝内复发，1例后颅窝内复发。5年精算无病存活率和总存活率分别为84%和85%。术后5年和10年后颅窝功能不全的生存率分别为100%和86%。5年后无远期失败的生存率为84%，全剂量颅脊放疗(36~39.6Gy)较小剂量(23.4GyVS 63%，P=0.06)有改善的趋势。未发现其他预测变量。结论：对肿瘤床进行适形治疗可显著保留关键结构。本组病例中后颅窝失败率与报道的治疗整个后颅窝时相似。这一方法应在第三阶段试验中进一步研究。
Purpose : To assess the patterns of failure for patients with medulloblastoma receiving a conformal tumor bed boost rather than a boost to the entire posterior fossa.Patients and Methods: From 1994 to 2002, 32 consecutive patients with newly diagnosed medulloblastoma treated at Memorial Sloan-Kettering Cancer Center (New York, NY) received a conformal boost to the tumor bed in conjunction with craniospinal radiation therapy. Twenty-eight patients also received chemotherapy. The median age was 9 years (range, 3 to 34 years), and the male to female ratio was 3:1. Twenty-seven patients had standard-risk disease, and five patients had high-risk disease. Craniospinal doses ranged from 23.4 to 39.6 Gy, and total tumor bed doses ranged from 54 to 59.4 Gy.Results: With a median follow-up of 56 months, six patients have relapsed; five relapsed outside of the posterior fossa, and one failed within the posterior fossa, outside of the high-dose boost volume. Five-year actuarial disease-free and overall survival rates were 84% and 85%, respectively. Freedom from posterior fossa failure was 100% and 86% at 5 and 10 years, respectively. Freedom from distant failure was 84% at 5 years, with a trend for improvement when full-dose craniospinal radiation (36 to 39.6 Gy) was used compared with a reduced dose (23.4 Gy) of radiation (100% v 63%, respectively, P =.06). No other predictive variables were identified.Conclusion: Conformal treatment to the tumor bed allows for significant sparing of critical structures. The posterior fossa failure rate in this series is similar to that reported when the entire posterior fossa is treated. This approach should be investigated further in a phase III trial.