Christopherson Kaitlin M, Bradley Julie A, Rotondo Ronny L, Pincus David W, Fort John A, Morris Christopher G, Mendenhall Nancy P, Marcus Robert B, Indelicato Daniel J
Department of Radiation Oncology, University of Florida , Gainesville, Florida , USA.
Acta Oncol. 2014 Sep;53(9):1151-7. doi: 10.3109/0284186X.2014.932434. Epub 2014 Jul 3.
A single-institution review of long-term outcomes and factors affecting local control (LC) following radiotherapy for non-metastatic medulloblastoma.
From 1963 to 2008, 50 children (median age, 7.3 years; range 1.2-18.5) with stage M0 medulloblastoma were treated with radiotherapy; half underwent a gross total resection (no visible residual tumor) or near-total resection (< 1.5 cm(3) of gross disease remaining after resection). Median craniospinal dose was 28.8 Gy (range 21.8-38.4 Gy). Median total dose to the posterior fossa was 54.3 Gy (range 42.4-64.8 Gy). Eighteen patients (36%) received chemotherapy as part of multimodality management, including 11 who received concurrent chemotherapy.
Median follow-up was 15.7 years (range 0.3-44.4 years) for all patients and 26.6 years (range 7.3-44.4 years) for living patients. The 10-year overall survival, cancer-specific survival, and progression-free survival rates were 65%, 65%, and 69%. The 10-year LC rate was 84% and did not significantly change across eras. Four percent of patients experienced local progression five years after treatment. On univariate analysis, chemotherapy and overall duration of radiotherapy ≤ 45 days were associated with improved LC. Patients receiving chemotherapy had a 10-year 100% LC rate versus 76% in patients not receiving chemotherapy (p = 0.0454). When overall radiotherapy treatment lasted ≤ 45 days, patients experienced a superior 95% 10-year LC rate (vs. 73% in patients treated > 45 days; p = 0.0419). Three patients (6%) died from treatment complications, including radionecrosis/cerebellar degeneration, severe cerebral edema leading to herniation, and secondary malignancy.
While we cannot draw definitive conclusions given the retrospective nature of our study, our long-term data suggest that reductions in craniospinal dose and boost target volume to reduce toxicity have not compromised disease control in the modern era. Our data also support analyses that implicate duration of radiotherapy, rather than interval between surgery and radiotherapy, as a factor in LC. Chemotherapy in multimodality management of medulloblastoma may have an underappreciated role in improving LC rates.
对非转移性髓母细胞瘤放疗后的长期预后及影响局部控制（LC）的因素进行单机构回顾性研究。
1963年至2008年，50例M0期髓母细胞瘤患儿（中位年龄7.3岁；范围1.2 - 18.5岁）接受了放疗；其中一半患儿接受了全切除（无可见残留肿瘤）或近全切除（切除后残留大体肿瘤<1.5 cm³）。颅脊髓照射的中位剂量为28.8 Gy（范围21.8 - 38.4 Gy）。后颅窝的中位总剂量为54.3 Gy（范围42.4 - 64.8 Gy）。18例患者（36%）接受了化疗作为多模式治疗的一部分，其中11例接受了同步化疗。
所有患者的中位随访时间为15.7年（范围0.3 - 44.4年），存活患者的中位随访时间为26.6年（范围7.3 - 44.4年）。10年总生存率、癌症特异性生存率和无进展生存率分别为65%、65%和69%。10年局部控制率为84%，不同时期无显著变化。4%的患者在治疗后5年出现局部进展。单因素分析显示，化疗和放疗总时长≤45天与局部控制改善相关。接受化疗的患者10年局部控制率为100%，未接受化疗的患者为76%（p = 0.0454）。当放疗总疗程≤45天时，患者10年局部控制率高达95%（而放疗疗程>45天的患者为73%；p = 0.0419）。3例患者（6%）死于治疗并发症，包括放射性坏死/小脑变性、导致脑疝的严重脑水肿和继发性恶性肿瘤。
鉴于本研究的回顾性性质，我们无法得出确定性结论，但我们的长期数据表明，在现代，降低颅脊髓剂量和缩小加量靶体积以降低毒性并未影响疾病控制。我们的数据还支持将放疗时长而非手术与放疗间隔作为局部控制的一个因素的分析。化疗在髓母细胞瘤的多模式治疗中对提高局部控制率可能具有未被充分认识的作用。
