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Brisson RJ, Indelicato DJ, Bradley JA, Aldana PR, Klawinski D, Cassidy V, Morris CG, Mailhot Vega RB. Long-term outcomes following proton therapy for non-metastatic central nervous system germinoma in children and adolescents. Radiother Oncol 2024; 198:110371. [PMID: 38857699 DOI: 10.1016/j.radonc.2024.110371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND/PURPOSE Radiation is a key component in the treatment of central nervous system pure germinoma (PG) in children and adolescents. Proton therapy (PT) improves normal tissue sparing and potentially reduces adverse effects (AE). The aim of this study was to present the largest single institution experience utilizing PT for the management of PG. MATERIALS METHODS We enrolled 35 non-metastatic patients with PG that were treated with PT at our institution between July 2007 - September 2021. Most received induction chemotherapy (n = 31, 89 %) and whole ventricular irradiation with an involved field boost (n = 29, 83 %). The most common total dose was 30 CGE (n = 18, 51.4 %). We utilized the cumulative incidence method to estimate local control (LC), freedom from distant metastases (FFDM), freedom from progression (FFP), and overall survival (OS). Treatment related toxicity was assessed per CTCAE version 5. RESULTS Median follow-up was 6.2 years (range, 0.9---15.2). The 10-year Kaplan-Meier estimates for LC, FFDM, FFP, and OS were 100 %, 100 %, 100 %, and 94 % respectively. The most common AE were hearing impairment requiring hearing aids (n = 3), transient hypersomnia requiring medication (n = 3), and new onset endocrinopathy (n = 1). Of the 23 evaluable patients ≥ 18 years old at last follow-up, 8 were high school graduates/in college, 8 college graduates, and 7 others gainfully employed. CONCLUSIONS When utilized in modern multimodality treatment of non-metastatic PG, the precise dosimetry of PT does not compromise disease control. Although serious radiation side effects are rare, the 100% cure rate supports further investigation into selective radiation dose and volume de-escalation.
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Affiliation(s)
- Ryan J Brisson
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States.
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Philipp R Aldana
- Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, United States
| | - Darren Klawinski
- Department of Pediatrics, Nemours Children's Specialty Clinic, Jacksonville, FL, United States
| | - Vincent Cassidy
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
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2
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Turcas A, Leucuta D, Balan C, Clementel E, Gheara C, Kacso A, Kelly SM, Tanasa D, Cernea D, Achimas-Cadariu P. Deep-learning magnetic resonance imaging-based automatic segmentation for organs-at-risk in the brain: Accuracy and impact on dose distribution. Phys Imaging Radiat Oncol 2023; 27:100454. [PMID: 37333894 PMCID: PMC10276287 DOI: 10.1016/j.phro.2023.100454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
Background and purpose Normal tissue sparing in radiotherapy relies on proper delineation. While manual contouring is time consuming and subject to inter-observer variability, auto-contouring could optimize workflows and harmonize practice. We assessed the accuracy of a commercial, deep-learning, MRI-based tool for brain organs-at-risk delineation. Materials and methods Thirty adult brain tumor patients were retrospectively manually recontoured. Two additional structure sets were obtained: AI (artificial intelligence) and AIedit (manually corrected auto-contours). For 15 selected cases, identical plans were optimized for each structure set. We used Dice Similarity Coefficient (DSC) and mean surface-distance (MSD) for geometric comparison and gamma analysis and dose-volume-histogram comparison for dose metrics evaluation. Wilcoxon signed-ranks test was used for paired data, Spearman coefficient(ρ) for correlations and Bland-Altman plots to assess level of agreement. Results Auto-contouring was significantly faster than manual (1.1/20 min, p < 0.01). Median DSC and MSD were 0.7/0.9 mm for AI and 0.8/0.5 mm for AIedit. DSC was significantly correlated with structure size (ρ = 0.76, p < 0.01), with higher DSC for large structures. Median gamma pass rate was 74% (71-81%) for Plan_AI and 82% (75-86%) for Plan_AIedit, with no correlation with DSC or MSD. Differences between Dmean_AI and Dmean_Ref were ≤ 0.2 Gy (p < 0.05). The dose difference was moderately correlated with DSC. Bland Altman plot showed minimal discrepancy (0.1/0) between AI and reference Dmean/Dmax. Conclusions The AI-model showed good accuracy for large structures, but developments are required for smaller ones. Auto-segmentation was significantly faster, with minor differences in dose distribution caused by geometric variations.
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Affiliation(s)
- Andrada Turcas
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, RTQA, Brussels, Belgium
- SIOP Europe, The European Society for Paediatric Oncology (SIOPE), QUARTET Project, Brussels, Belgium
- University of Medicine and Pharmacy and Medicine “Iuliu Hatieganu”, Oncology Department, Cluj-Napoca, Romania
- Oncology Institute “Prof. Dr. Ion Chiricuta”, Radiotherapy Department, Cluj-Napoca, Romania
| | - Daniel Leucuta
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Department of Medical Informatics and Biostatistics, Cluj-Napoca, Romania
| | - Cristina Balan
- Oncology Institute “Prof. Dr. Ion Chiricuta”, Radiotherapy Department, Cluj-Napoca, Romania
- “Babes-Bolyai” University, Faculty of Physics, Cluj-Napoca, Romania
| | - Enrico Clementel
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, RTQA, Brussels, Belgium
| | - Cristina Gheara
- Oncology Institute “Prof. Dr. Ion Chiricuta”, Radiotherapy Department, Cluj-Napoca, Romania
- “Babes-Bolyai” University, Faculty of Physics, Cluj-Napoca, Romania
| | - Alex Kacso
- University of Medicine and Pharmacy and Medicine “Iuliu Hatieganu”, Oncology Department, Cluj-Napoca, Romania
- Oncology Institute “Prof. Dr. Ion Chiricuta”, Radiotherapy Department, Cluj-Napoca, Romania
| | - Sarah M. Kelly
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, RTQA, Brussels, Belgium
- SIOP Europe, The European Society for Paediatric Oncology (SIOPE), QUARTET Project, Brussels, Belgium
| | - Delia Tanasa
- Oncology Institute “Prof. Dr. Ion Chiricuta”, Radiotherapy Department, Cluj-Napoca, Romania
| | - Dana Cernea
- Oncology Institute “Prof. Dr. Ion Chiricuta”, Radiotherapy Department, Cluj-Napoca, Romania
| | - Patriciu Achimas-Cadariu
- University of Medicine and Pharmacy and Medicine “Iuliu Hatieganu”, Oncology Department, Cluj-Napoca, Romania
- Oncology Institute “Prof. Dr. Ion Chiricuta”, Surgery Department, Cluj-Napoca, Romania
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Franceschi E, Giannini C, Furtner J, Pajtler KW, Asioli S, Guzman R, Seidel C, Gatto L, Hau P. Adult Medulloblastoma: Updates on Current Management and Future Perspectives. Cancers (Basel) 2022; 14:cancers14153708. [PMID: 35954372 PMCID: PMC9367316 DOI: 10.3390/cancers14153708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Medulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa belonging to the family of primitive neuro-ectodermic tumors (PNET). MB generally occurs in pediatric age, but in 14–30% of cases, it affects the adults, mostly below the age of 40, with an incidence of 0.6 per million per year, representing about 0.4–1% of tumors of the nervous system in adults. Unlike pediatric MB, robust prospective trials are scarce for the post-puberal population, due to the low incidence of MB in adolescent and young adults. Thus, current MB treatments for older patients are largely extrapolated from the pediatric experience, but the transferability and applicability of these paradigms to adults remain an open question. Adult MB is distinct from MB in children from a molecular and clinical perspective. Here, we review the management of adult MB, reporting the recent published literature focusing on the effectiveness of upfront chemotherapy, the development of targeted therapies, and the potential role of a reduced dose of radiotherapy in treating this disease.
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Affiliation(s)
- Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy
- Correspondence:
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 59005, USA;
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
| | - Julia Furtner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Kristian W. Pajtler
- Hopp Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), 69120 Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy;
- Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139 Bologna, Italy
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Lidia Gatto
- Department of Oncology, AUSL of Bologna, 40139 Bologna, Italy;
| | - Peter Hau
- Wilhelm Sander NeuroOncology Unit & Department of Neurology, University Hospital Regensburg, 93055 Regensburg, Germany;
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Parakh S, Davies A, Westcott K, Roos D, Abou-Hamden A, Ahern E, Lau PKH, Cheruvu S, Pranavan G, Pullar A, Lynam J, Gzell C, Whittle JR, Cain S, Inglis PL, Harrup R, Anazodo A, Hovey E, Cher L, Gan HK. Adult medulloblastoma in an Australian population. J Clin Neurosci 2022; 102:65-70. [PMID: 35728397 DOI: 10.1016/j.jocn.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Abstract
Medulloblastoma in adult patients is a rare condition with limited contemporary demographic and treatment outcome data available in an Australian population. We conducted a retrospective review of patterns of care and outcomes of adult patients diagnosed with medulloblastoma treated at major neuro-oncology centres across Australia between January 2010 and December 2019. A total of 80 patients were identified and the median follow-up after diagnosis was 59.2 (range 0.5-204) months. A variety of chemotherapy regimens were used in the adjuvant and recurrent settings. The median overall survival (mOS) was 78 months (IQR 17.5-94.8). Patients who had no residual disease post-resection or with SHH-subtype tumours had a numerically longer 5-year survival rate than those with residual disease post resection or non-SHH subtypes respectively. The median time to recurrence from diagnosis was 18.4 months. The median OS from 1st relapse was 22.1 months (95% CI 11.7-31.4) and mOS from second relapse was 10.2 months (95% CI 6.6 - NR). This is the largest dataset examining patterns of care of adult patients with medulloblastoma in an Australian population. Substantial variation existed in the chemotherapy agents used in the adjuvant and recurrent setting. As has been demonstrated in a paediatric population, trials such as the upcoming EORTC 1634-BTG/NOA-23 trial (PersoMed-1 study) which are tailoring treatments to molecular profiles are likely to improve outcome in adult medulloblastoma.
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Affiliation(s)
- Sagun Parakh
- Olivia Newton John Cancer Research Institute, Melbourne, Australia; Austin Health, Melbourne, Australia; La Trobe University, School of Cancer Medicine, Heidelberg, Victoria, Australia.
| | | | - Kerryn Westcott
- Olivia Newton John Cancer Research Institute, Melbourne, Australia
| | - Daniel Roos
- Royal Adelaide Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia
| | - Amal Abou-Hamden
- Royal Adelaide Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia
| | - Elizabeth Ahern
- Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | | | | | - Ganesalingam Pranavan
- The Canberra Hospital, Canberra, Australia; The Australian National University, Canberra, Australia
| | | | - James Lynam
- Calvary Mater Newcastle, Newcastle, Australia; University of Newcastle, Newcastle, Australia
| | | | - James R Whittle
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Medical Biology, The University of Melbourne, Melbourne, Australia; Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Sarah Cain
- Royal Melbourne Hospital, Melbourne, Australia
| | - Po-Ling Inglis
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Antoinette Anazodo
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales
| | | | - Hui K Gan
- Olivia Newton John Cancer Research Institute, Melbourne, Australia; Austin Health, Melbourne, Australia; La Trobe University, School of Cancer Medicine, Heidelberg, Victoria, Australia; Department of Medical Biology, The University of Melbourne, Melbourne, Australia
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Saraf A, Yock TI, Niemierko A, Oh KS, Curry WT, Butler WE, Forst DA, Arrillaga-Romany I, Ebb DH, Tarbell NJ, MacDonald S, Loeffler JS, Shih HA. Long-term outcomes and late toxicity of adult medulloblastoma treated with combined modality therapy: A contemporary single-institution experience. Neuro Oncol 2022; 24:2180-2189. [PMID: 35671386 PMCID: PMC9713502 DOI: 10.1093/neuonc/noac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Medulloblastoma (MB) is a rare central nervous system malignancy of adults, with limited contemporary studies to define treatment guidelines and expected late toxicity. METHODS A single-center, retrospective study was conducted of patients age ≥18 years from 1997-2019 with MB and who were treated with postoperative radiotherapy. Late toxicity was defined as a minimum of 18 months from diagnosis. Overall survival (OS) and progression-free survival (PFS) were characterized using Kaplan-Meier and Cox regression analyses. RESULTS Fifty-nine patients met criteria, with median age of 25 years (range 18-62 y) and median follow-up of 6.5 years (range 0.7-23.1 y). At diagnosis, 68% were standard-risk, 88% Chang M0, and 22% with anaplastic histology. Gross total resection was achieved in 75%; median craniospinal irradiation dose was 30.6 Gy (relative biological effectiveness [RBE]), median total dose was 54.0 Gy (RBE), 80% received proton radiotherapy; 81% received chemotherapy. 5 year PFS and OS were 86.5% and 95.8%, respectively; 10 year PFS and OS were 83.9% and 90.7%, respectively. Anaplastic histology was associated with worse PFS (P = .04). Among eight recurrences, 25% presented after 5 years. Most common grade ≥2 late toxicities were anxiety/depressive symptoms (30%), motor dysfunction (25%), and ototoxicity (22%). Higher posterior fossa radiation dose was associated with increased risk of late toxicity, including worse cognitive dysfunction (P = .05). CONCLUSIONS Adults with MB have favorable survival outcomes, but late failures and toxicity are not uncommon. Better understanding of prognostic factors, possibly from molecular subtyping, may help to define more personalized treatments for patients with high risk of recurrence and long-term treatment sequelae.
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Affiliation(s)
- Anurag Saraf
- Harvard Radiation Oncology Program, Boston, Massachusetts, USA,Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin S Oh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William T Curry
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William E Butler
- Department of Pediatric Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deborah A Forst
- Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - David H Ebb
- Department of Pediatric Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy J Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shannon MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jay S Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA,Inspire Oncology, Naples, Florida, USA
| | - Helen A Shih
- Corresponding Author: Helen A. Shih, MD, MS, MPH, Massachusetts General Hospital, 30 Fruit St., Boston, MA 02114, USA ()
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