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Oliveira C, Huang J, Onar A, Robinson GW, Gajjar A, Merchant TE. Dose-Effect of Proton and Photon Craniospinal Irradiation on Vertebral Growth in Pediatric Patients with Medulloblastoma. Int J Radiat Oncol Biol Phys 2023; 117:S77-S78. [PMID: 37784571 DOI: 10.1016/j.ijrobp.2023.06.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Craniospinal irradiation (CSI) directly damages vertebral growth plates causing skeletal dysplasia leading to reduced height in pediatric long-term survivors. The objective of this study is to quantify the adjusted effect of CSI on standing and sitting height by radiation dose and modality in children. MATERIALS/METHODS Two hundred sixty-five patients (M/F 169/96) were treated at a single institution on a clinical and molecular risk-directed trial for medulloblastoma (NCT01878617) using proton or photon therapy. Three CSI dose regimens were evaluated: 15 Gy (n = 31), 23.4 Gy (n = 103), ≥36 Gy (n = 131). Vertebral body dose was limited to 18-20 CGE for 23.4 Gy or 36 Gy proton therapy. All patients received post-CSI protocol-specified chemotherapy. Non-parametric tests were applied for baseline patient comparison. Changes in growth over time were calculated using random coefficients models using patient-specific intercepts and slopes. Dose-effects were modeled for ages 5, 10, and 18 years. RESULTS Age at CSI and race were similar between the three dose levels. Females most often received 23.4 Gy and males ≥36 Gy (p = 0.001). Higher CSI doses were associated with photon therapy (p<0.001). Median follow-up was 3 years (range 0.1-7.1). Annual growth rate was significantly different between 15 Gy (3.66 cm/year) and the higher dose levels of 23.4 Gy (2.81 cm/year, p = 0.0389) and ≥36 Gy (2.46 cm/year, p = 0.0032). Lower annual growth rate in females (vs. males, p = 0.0331) was observed in models for those aged 5 (-0.17 cm/year), 10 (-0.35 cm/year), and 18 years (-0.62 cm/year). In multivariate analysis, modelled annual growth rate was dose-dependent at ages 5 and 10 years. The differences were, respectively, 1.68 cm/year between 15 and 23.4 Gy (p = 0.0005) and 0.98 cm/year between 23.4 and ≥36 Gy (p = 0.0002), and 1.13 cm/year between 15 and 23.4 Gy (p = 0.0002) and 0.68 cm/year between 23.4 and ≥36 Gy (p = 0.0003). Radiation modality did not impact standing height over time significantly. Annual sitting height growth was 2.34, 1.67 and 1.1 cm/year for the three dose levels (p<0.0001-0.001). In the multivariate model, a 5-year-old receiving 15 or 23.4 Gy had similar annual sitting height growth, but not when 23.4 Gy was compared to ≥36 Gy (0.83 cm/year, p<0.0001). In a separate model for a patient aged 10 years, there was a difference comparing all CSI regimens (0.81 cm/year, p<0.0001, 15 vs 23.4 Gy; 0.54 cm/year, p = 0.0002, 23.4 vs ≥36 Gy). Sitting height growth was affected by CSI dose at age 18 years, with a difference of 2.2 cm/year between 15 vs 23.4 Gy (p = 0.0013), and no difference between 23.4 and ≥36 Gy. CONCLUSION Annual growth rates show a dose-response relationship, independent of treatment modality. A dose-response in sitting height growth rate is seen at any age, while the annual standing height growth rate was only affected by CSI dose in 5- and 10-year-olds. While all CSI doses had a significant impact on the annual standing height, sitting height growth rates approximated normal values for those treated with a low CSI dose.
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Affiliation(s)
- C Oliveira
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - J Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - A Onar
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - G W Robinson
- St. Jude Children's Research Hospital, Memphis, TN
| | - A Gajjar
- St. Jude Children's Research Hospital, Memphis, TN
| | - T E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
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Hoffman LM, Donson AM, Nakachi I, Griesinger AM, Birks DK, Amani V, Hemenway MS, Liu AK, Wang M, Hankinson TC, Handler MH, Foreman NK, Zakrzewska M, Zakrzewski K, Fendler W, Stefanczyk L, Liberski PP, Massimino M, Gandola L, Ferroli P, Valentini L, Biassoni V, Garre ML, Sardi I, Genitori L, Giussani C, Massimi L, Bertin D, Mussano A, Viscardi E, Modena P, Mastronuzzi A, Barra S, Scarzello G, Cinalli G, Peretta P, Giangaspero F, Massimino M, Boschetti L, Biassoni V, Garre ML, Schiavello E, Sardi I, Genitori L, Bertin D, Modena P, Calareso G, Barra S, Scarzello G, Cinalli G, Peretta P, Mastronuzzi A, Giussani C, Giangaspero F, Antonelli M, Pecori E, Gandola L, Massimino M, Biassoni V, Di Meco F, Garre ML, Schiavello E, Sardi I, Genitori L, Bertin D, Viscardi E, Modena P, Barra S, Scarzello G, Cinalli G, Peretta P, Migliorati R, Taborelli A, Giangaspero F, Antonelli M, Pecori E, Gandola L, Witt H, Sill M, Wani K, Mack SC, Capper D, Pajtler K, Lambert S, Tzaridis T, Milde T, Northcott PA, Kulozik AE, Witt O, Collins VP, Ellison DW, Taylor MD, Kool M, Jones DTW, Korshunov A, Ken A, Pfister SM, Makino K, Nakamura H, Kuroda JI, Kuratsu JI, Toledano H, Margolin Y, Ohali A, Michowiz S, Witt H, Johann P, Tzaridis T, Tabori U, Walker E, Hawkins C, Taylor M, Yaniv I, Avigad S, Hoffman L, Plimpton SR, Foreman NK, Stence NV, Hankinson TC, Handler MH, Hemenway MS, Vibhakar R, Liu AK, Lourdusamy A, Rahman R, Ward J, Rogers H, Grundy R, Punchihewa C, Lee R, Lin T, Orisme W, Dalton J, Aronica E, Smith A, Gajjar A, Onar A, Pounds S, Tatevossian R, Merchant T, Ellison D, Parker M, Mohankumar K, Punchihewa C, Weinlich R, Dalton J, Tatevossian R, Phoenix T, Thiruvenkatam R, White E, Gupta K, Gajjar A, Merchant T, Boop F, Smith A, Ding L, Mardis E, Wilson R, Downing J, Ellison D, Gilbertson R, Ward J, Lourdusamy A, Speed D, Gould T, Grundy R, Rahman R, Mack SC, Witt H, Pfister SM, Korshunov A, Taylor MD, Consortium TIE, Hoffman LM, Griesinger A, Donson A, Birks D, Amani V, Foreman NK, Ohe N, Yano H, Nakayama N, Iwama T, Wright K, Hassall T, Bowers DC, Crawford J, Bendel A, Fisher PG, Merchant T, Ellison D, Klimo P, Boop F, Armstrong G, Qaddoumi I, Robinson G, Wetmore C, Broniscer A, Gajjar A, Rogers H, Chapman R, Mayne C, Duane H, Kilday JP, Coyle B, Grundy R, Graul-Conroy A, Hartsell W, Bragg T, Goldman S, Rebsamen S, Puccetti D, Salamat S, Patel NJ, Gomi A, Oguma H, Hayase T, Kawahara Y, Yagi M, Morimoto A, Wilbur C, Dunham C, Hawkins C, Tabori U, Mabbott D, Carret AS, Lafay-Cousin L, McNeely PD, Eisenstat D, Wilson B, Johnston D, Hukin J, Mynarek M, Kortmann RD, Kaatsch P, Pietsch T, Timmermann B, Fleischhack G, Benesch M, Friedrich C, von Bueren AO, Gerber NU, Muller K, Tippelt S, Warmuth-Metz M, Rutkowski S, von Hoff K, Murugesan MK, White E, Poppleton H, Thiruvenkatam R, Gupta K, Currle S, Kranenburg T, Eden C, Wright K, Ellison D, Gilbertson R, Boulos N, Dapper J, Patel Y, Wright K, Mohankumar K, Freeman B, Gajjar A, Shelat A, Stewart C, Guy R, Gilbertson R, Adamski J, Taylor M, Tabori U, Huang A, Bartels U, Ramaswamy V, Krishnatry R, Laperriere N, Hawkins C, Bouffet E, Araki A, Chocholous M, Gojo J, Dorfer C, Czech T, Dieckmann K, Slavc I, Haberler C, Pietsch T, Mynarek M, Doerner E, Muehlen AZ, Warmuth-Metz M, Kortmann R, von Buehren A, Friedrich C, von Hoff K, Rutkowski S, von Hoff K, Kortmann RD, Gerber NU, Mynarek M, Muller K, Friedrich C, von Bueren AO, Benesch M, Warmuth-Metz M, Ottensmeier H, Resch A, Kwiecien R, Faldum A, Kuehl J, Pietsch T, Rutkowski S, Sabnis D, Storer L, Simmonds L, Blackburn S, Lowe J, Grundy R, Kerr I, Coyle B, Pietsch T, Wohlers I, Goschzik T, Dreschmann V, Denkhaus D, Doerner E, Rahmann S, Klein-Hitpass L, Iglesias MJL, Riet FG, Dhermain FD, Canale S, Dufour C, Rose CS, Puget S, Grill J, Bolle S, Parkes J, Davidson A, Figaji A, Pillay K, Kilborn T, Padayachy L, Hendricks M, Van Eyssen A, Piccinin E, Lorenzetto E, Brenca M, Massimino M, Modena P, Taylor M, Ramaswamy V, Bouffet E, Aldape K, Cho YJ, Weiss W, Phillips J, Jabado N, Mora J, Fan X, Jung S, Lee JY, Zitterbart K, French P, Kros JM, Hauser P, Faria C, Korshunov A, Pfister S, Mack SC. EPENDYMOMA. Neuro Oncol 2014; 16:i17-i25. [PMCID: PMC4046284 DOI: 10.1093/neuonc/nou068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
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Carvalho D, Bjerke L, Bax D, Chen L, Kozarewa I, Baker S, Grundy R, Ashworth A, Lord C, Hargrave D, Reis RM, Jones C, Bender S, Feng W, Jones DT, Kool M, Cin H, Pleier S, Hutter S, Sturm D, Liu HK, Korshunov A, Lichter P, Pfister SM, Alimova I, Birks DK, Harris P, Venkataraman S, Marquez VE, Foreman NK, Vibhakar R, Whiteway S, Harris P, Venkataraman S, Birks DK, Donson A, Foreman NK, Vibhakar R, Xipell E, Jauregui P, Gonzalez M, tejada-solis S, Diez-Valle R, Tunon T, Zazpe I, Zazpe I, Mora J, Carcaboso AM, Gomez-MAnzano C, Fueyo J, Alonso M, Dorris K, Sobo M, Holden P, Panditharatna E, Li S, Margol A, Stephenson C, Miles L, Goldman S, Asgharzadeh S, Onar A, Fouladi M, Drissi R, Erdreich-Epstein A, Ren X, Zhou H, Snyder K, Stamper M, Perez J, Nazarian J, Gershon T, Crowther A, Garcia I, Gama V, Yuan H, Chang S, Deshmukh M, Hutt M, Goldstein W, Nazarian J, Price A, Lim KJ, Warren K, Chang H, Eberhart CG, Raabe EH, Karakoula K, Phipps KP, Harkness W, Hayward R, Thompson D, Jacques TS, Darling JL, Warr TJ, Guldal C, Potts C, Rotenberry R, Kenney AM, Amani V, Griesinger AM, Donson AM, Bemis LT, Birks DK, Schittone SK, Morgan M, Thorburn A, Foreman NK, Mulcahy-Levy J, Kolkowitz I, Andor N, Jensen T, Banerjee A, Gupta N, Petritsch C, Taylor M, Hashizume R, Tom M, Haas-Kogan D, Mueller S, Stearns D, Ma N, Eberhart CG, Levy R, Gate D, Rodriguez J, Breunig J, Danielpour M, Town T. LAB-PEDIATRICS LABORATORY RESEARCH. Neuro Oncol 2012; 14:vi116-vi119. [PMCID: PMC3488789 DOI: 10.1093/neuonc/nos235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
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Li KKW, Pang JCS, Ng HK, Massimino M, Gandola L, Biassoni V, Spreafico F, Schiavello E, Poggi G, Casanova M, Pecori E, De Pava MV, Ferrari A, Meazza C, Terenziani M, Polastri D, Luksch R, Podda M, Modena P, Antonelli M, Giangaspero F, Ahmed S, Zaghloul MS, Mousa AG, Eldebawy E, Elbeltagy M, Awaad M, Massimino M, Gandola L, Biassoni V, Antonelli M, Schiavello E, Buttarelli F, Spreafico F, Collini P, Pollo B, Patriarca C, Giangaspero F, MacDonald T, Liu J, Munson J, Park J, Wang K, Fei B, Bellamkonda R, Arbiser J, Gomi A, Yamaguchi T, Mashiko T, Oguro K, Somasundaram A, Neuberg R, Grant G, Fuchs H, Driscoll T, Becher O, McLendon R, Cummings T, Gururangan S, Bourdeaut F, Grison C, Doz F, Pierron G, Delattre O, Couturier J, Cho YJ, Pugh T, Weeraratne SD, Archer T, Krummel DP, Auclair D, Cibulkis K, Lawrence M, Greulich H, McKenna A, Ramos A, Shefler E, Sivachenko A, Amani V, Pierre-Francois J, Teider N, Northcott P, Taylor M, Meyerson M, Pomeroy S, Potts C, Cline H, Rotenberry R, Guldal C, Bhatia B, Nahle Z, Kenney A, Fan YN, Pizer B, See V, Makino K, Nakamura H, Kuratsu JI, Grahlert J, Ma M, Fiaschetti G, Shalaby T, Grotzer M, Baumgartner M, Clifford S, Gustafsson G, Ellison D, Figarella-Branger D, Doz F, Rutkowski S, Lannering B, Pietsch T, Fiaschetti G, Shalaby T, Baumgartner M, Grotzer M, Fleischhack G, Siegler N, Zimmermann M, Rutkowski S, Warmuth-Metz M, Kortmann RD, Pietsch T, Faldum A, Bode U, Yoon JH, Kang HJ, Park KD, Park SH, Phi JH, Kim SK, Wang KC, Kim IH, Shin HY, Ahn HS, Faria C, Golbourn B, Smith C, Rutka J, Greene BD, Whitton A, Singh S, Scheinemann K, Hill R, Lindsey J, Howell C, Ryan S, Shiels K, Shrimpton E, Bailey S, Clifford S, Schwalbe E, Lindsey J, Williamson D, Hamilton D, Northcott P, O'Toole K, Nicholson SL, Lusher M, Gilbertson R, Hauser P, Taylor M, Taylor R, Ellison D, Bailey S, Clifford S, Kool M, Jones DTW, Jager N, Hovestadt V, Schuller U, Jabado N, Perry A, Cowdrey C, Croul S, Collins VP, Cho YJ, Pomeroy S, Eils R, Korshunov A, Lichter P, Pfister S, Northcott P, Shih D, Taylor M, Darabi A, Sanden E, Visse E, Siesjo P, Harris P, Venkataraman S, Alimova I, Birks D, Cristiano B, Donson A, Foreman N, Vibhakar R, Bertin D, Vallero S, Basso ME, Romano E, Peretta P, Morra I, Mussano A, Fagioli F, Kunkele A, De Preter K, Heukamp L, Thor T, Pajtler K, Hartmann W, Mittelbronn M, Grotzer M, Deubzer H, Speleman F, Schramm A, Eggert A, Schulte J, Bandopadhayay P, Kieran M, Manley P, Robison N, Chi S, Thor T, Mestdagh P, Vandesomple J, Fuchs H, Durner VG, de Angelis MH, Heukamp L, Kunkele A, Pajtler K, Eggert A, Schramm A, Schulte JH, Ohe N, Yano H, Nakayama N, Iwama T, Lastowska M, Perek-Polnik M, Grajkowska W, Malczyk K, Cukrowska B, Dembowska-Baginska B, Perek D, Othman RT, Storer L, Grundy R, Kerr I, Coyle B, Hulleman E, Lagerweij T, Biesmans D, Crommentuijn MHW, Cloos J, Tannous BA, Vandertop WP, Noske DP, Kaspers GJL, Wurdinger T, Bergthold G, El Kababri M, Varlet P, Dhermain F, Sainte-Rose C, Raquin MA, Valteau-Couanet D, Grill J, Dufour C, Burchill C, Hii H, Dallas P, Cole C, Endersby R, Gottardo N, Gevorgian A, Morozova E, Kazantsev I, Youhta T, Safonova S, Kozlov A, Punanov Y, Afanasyev B, Zheludkova O, Packer R, Gajjar A, Michalski J, Jakacki R, Gottardo N, Tarbell N, Vezina G, Olson J, Friedrich C, von Bueren AO, von Hoff K, Gerber NU, Benesch M, Faldum A, Pietsch T, Warmuth-Metz M, Kuehl J, Kortmann RD, Rutkowski S, Malbari F, Atlas M, Friedman G, Kelly V, Bray A, Cassady K, Markert J, Gillespie Y, Taylor R, Howman A, Brogden E, Robinson K, Jones D, Gibson M, Bujkiewicz S, Mitra D, Saran F, Michalski A, Pizer B, Jones DTW, Jager N, Kool M, Zichner T, Hutter B, Sultan M, Cho YJ, Pugh TJ, Warnatz HJ, Reifenberger G, Northcott PA, Taylor MD, Meyerson M, Pomeroy SL, Yaspo ML, Korbel JO, Korshunov A, Eils R, Pfister SM, Lichter P, Pajtler KW, Weingarten C, Thor T, Kuenkele A, Fleischhack G, Heukamp LC, Buettner R, Kirfel J, Eggert A, Schramm A, Schulte JH, Friedrich C, von Bueren AO, von Hoff K, Gerber NU, Benesch M, Kwiecien R, Pietsch T, Warmuth-Metz M, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Lupo P, Scheurer M, Martin A, Nirschl C, Polanczyk M, Cohen KJ, Pardoll DM, Drake CG, Lim M, Manoranjan B, Hallett R, Wang X, Venugopal C, McFarlane N, Sheinemann K, Hassell J, Singh S, Venugopal C, Manoranjan B, McFarlane N, Whitton A, Delaney K, Scheinemann K, Singh S, Manoranjan B, Hallett R, Venugopal C, McFarlane N, Hassell J, Scheinemann K, Dunn S, Singh S, Garcia I, Crowther AJ, Gama V, Miller CR, Deshmukh M, Gershon TR, Garcia I, Crowther AJ, Gershon TR, Gerber NU, von Hoff K, Friedrich C, von Bueren AO, Treulieb W, Benesch M, Faldum A, Pietsch T, Warmuth-Metz M, Rutkowski S, Kortmann RD, Zin A, De Bortoli M, Bonvini P, Viscardi E, Perilongo G, Rosolen A, Connolly E, Zhang C, Anderson R, Feldstein N, Stark E, Garvin J, Shing MMK, Lee V, Cheng FWT, Leung AWK, Zhu XL, Wong HT, Kam M, Li CK, Ward S, Sengupta R, Kroll K, Rubin J, Dallas P, Milech N, Longville B, Hopkins R, Vergiliana JVD, Endersby R, Gottardo N, von Bueren AO, Gerss J, Hagel C, Cai H, Remke M, Hasselblatt M, Feuerstein BG, Pernet S, Delattre O, Korshunov A, Rutkowski S, Pfister SM, Baudis M, Lee C, Fotovati A, Triscott J, Dunn S, Valdora F, Freier F, Seyler C, Brady N, Bender S, Northcott P, Kool M, Jones D, Coco S, Tonini GP, Scheurlen W, Boutros M, Taylor M, Katus H, Kulozik A, Zitron E, Korshunov A, Lichter P, Pfister S, Remke M, Shih DJH, Northcott PA, Van Meter T, Pollack IF, Van Meir E, Eberhart CG, Fan X, Dellatre O, Collins VP, Jones DTW, Clifford SC, Pfister SM, Taylor MD, Pompe R, von Bueren AO, von Hoff K, Friedrich C, Treulieb W, Lindow C, Deinlein F, Kuehl J, Rutkowski S, Gupta T, Krishnatry R, Shirsat N, Epari S, Kunder R, Kurkure P, Vora T, Moiyadi A, Jalali R, Cohen K, Perek D, Perek-Polnik M, Dembowska-Baginska B, Drogosiewicz M, Grajkowska W, Lastowska M, Chojnacka M, Filipek I, Tarasinska M, Roszkowski M, Hauser P, Jakab Z, Bognar L, Markia B, Gyorsok Z, Ottoffy G, Nagy K, Cservenyak J, Masat P, Turanyi E, Vizkeleti J, Krivan G, Kallay K, Schuler D, Garami M, Lacroix J, Schlund F, Adolph K, Leuchs B, Bender S, Hielscher T, Pfister S, Witt O, Schlehofer JR, Rommelaere J, Witt H, Leskov K, Ma N, Eberhart C, Stearns D, Dagri JN, Torkildson J, Evans A, Ashby LS, Zakotnik B, Brown RJ, Dhall G, Portnow J, Finlay JL, McCabe M, Pizer B, Marino AM, Baryawno N, Ekstrom TP, Ostman A, Johnsen JI, Robinson G, Parker M, Kranenburg T, Lu C, Pheonix T, Huether R, Easton J, Onar A, Lau C, Bouffet E, Gururangan S, Hassall T, Cohn R, Gajjar A, Ellison D, Mardis E, Wilson R, Downing J, Zhang J, Gilbertson R, Robinson G, Dalton J, O'Neill T, Yong W, Chingtagumpala M, Bouffet E, Bowers D, Kellie S, Gururangan S, Fisher P, Bendel A, Fisher M, Hassall T, Wetmore C, Broniscer A, Clifford S, Gilbertson R, Gajjar A, Ellison D, Zhukova N, Martin D, Lipman T, Castelo-Branco P, Zhang C, Fraser M, Baskin B, Ray P, Bouffet E, Alman B, Ramaswamy V, Dirks P, Clifford S, Rutkowski S, Pfister S, Bristow R, Taylor M, Malkin D, Hawkins C, Tabori U, Dhall G, Ji L, Haley K, Gardner S, Sposto R, Finlay J, Leary S, Strand A, Ditzler S, Heinicke G, Conrad L, Richards A, Pedro K, Knoblaugh S, Cole B, Olson J, Yankelevich M, Budarin M, Konski A, Mentkevich G, Stefanits H, Ebetsberger-Dachs G, Weis S, Haberler C, Milosevic J, Baryawno N, Sveinbjornsson B, Martinsson T, Grotzer M, Johnsen JI, Kogner P, Garzia L, Morrisy S, Jelveh S, Lindsay P, Hill R, Taylor M, Marks A, Zhang H, Rood B, Williamson D, Clifford S, Aurtenetxe O, Gaffar A, Lopez JI, Urberuaga A, Navajas A, O'Halloran K, Hukin J, Singhal A, Dunham C, Goddard K, Rassekh SR, Davidson TB, Fangusaro JR, Ji L, Sposto R, Gardner SL, Allen JC, Dunkel IJ, Dhall G, Finlay JL, Trivedi M, Tyagi A, Goodden J, Chumas P, O'kane R, Crimmins D, Elliott M, Picton S, Silva DS, Viana-Pereira M, Stavale JN, Malheiro S, Almeida GC, Clara C, Jones C, Reis RM, Spence T, Sin-Chan P, Picard D, Ho KC, Lu M, Huang A, Bochare S, Khatua S, Gopalakrishnan V, Chan TSY, Picard D, Pfister S, Hawkins C, Huang A, Chan TSY, Picard D, Ho KC, Huang A, Picard D, Millar S, Hawkins C, Rogers H, Kim SK, Ra YS, Fangusaro J, Toledano H, Nakamura H, Van Meter T, Pomeroy S, Ng HK, Jones C, Gajjar A, Clifford S, Pfister S, Eberhart C, Bouffet E, Grundy R, Huang A, Sengupta S, Weeraratne SD, Phallen J, Sun H, Rallapalli S, Amani V, Pierre-Francois J, Teider N, Cook J, Jensen F, Lim M, Pomeroy S, Cho YJ. MEDULLOBLASTOMA. Neuro Oncol 2012; 14:i82-i105. [PMCID: PMC3483339 DOI: 10.1093/neuonc/nos093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
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Murray JC, Rainusso N, Roberts RA, Gomez AM, Egler R, Russell H, Okcu MF, Gururangan S, Fangusaro J, Young-Poussaint T, Lesh S, Onar A, Gilbertson R, Packer R, McLendon R, Friedman HS, Boyett J, Kun LE, Venkatramani R, Haley K, Gilles F, Sposto R, Ji L, Olshefski R, Garvin J, Tekautz T, Kennedy G, Rassekh R, Moore T, Gardner S, Allen J, Shore R, Moertel C, Atlas M, Lasky J, Finlay J, Valera ET, Brassesco MS, Scrideli CA, Oliveira RS, Machado HR, Tone LG, Finlay JL, Kreimer S, Dagri J, Grimm J, Bluml S, Britt B, Dhall G, Gilles F, Finlay JL, Brown RJ, Dhall G, Shah A, Kapoor N, Abdel-Azim H, Rao AAN, Wallace D, Boyett J, Gajjar A, Packer RJ, Pearlman ML, Sadighi Z, Bingham R, Vats T, Khatua S, Ko RH, O'Neil S, Lavey RS, Finlay JL, Dhall G, Davidson TB, Gilles F, Tovar J, Grimm J, Wong K, Olch A, Dhall G, Finlay JL, Murray JC, Honeycutt JH, Donahue DJ, Head HW, Alles AJ, Ray A, Pearlman M, Vats T, Khatua S, Baskin J, Qaddoumi I, Ahchu MS, Alabi SF, Arambu IC, Castellanos M, Gamboa Y, Martinez R, Montero M, Ocampo E, Howard SC, Finlay JL, Broniscer A, Baker SD, Baker JN, Panandiker AP, Onar-Thomas A, Chin TK, Merchant TE, Davidoff A, Kaste SC, Gajjar A, Stewart CF, Espinoza J, Haley K, Patel N, Dhall G, Gardner S, Jeffrey A, Torkildson J, Cornelius A, Rassekh R, Bedros A, Etzl M, Garvin J, Pradhan K, Corbett R, Sullivan M, McGowage G, Puccetti D, Stein D, Jasty R, Ji L, Sposto R, Finlay JL, Antony R, Gardner S, Patel M, Wong KE, Britt B, Dhall G, Grimm J, Krieger M, McComb G, Gilles F, Sposto R, Finlay JL, Davidson TB, Sanchez-Lara PA, Randolph LM, Krieger MD, Wu S, Panigrahy A, Shimada H, Erdreich-Epstein A, Puccetti DM, Patel N, Kennedy T, Salamat S, Bradfield Y, Park HJ, Yoon JH, Ahn HS, Shin HY, Kim SK, Im HJ, Ra YS, Won SC, Baek HJ, Sung KW, Hah JO, Lim YT, Lee GS, Lee YH, Kim HS, Park JK, Kim MK, Park JE, Chung NG, Choi HS, Campen CJ, Fisher PG, Ruge MI, Simon T, Suchorska B, Lehrke R, Hamisch C, Koerber F, Treuer H, Berthold F, Sturm V, Voges J, Davidson TB, Finlay JL, Dhall G, Kirsch M, Lindner C, Schackert G, Brown RJ, Krieger M, Dhall G, Finlay JL. PEDIATRICS CLINICAL RESEARCH. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wrede B, Peters O, Kordes U, Kutluk T, Hasselblatt M, Rytting M, Rutkowski S, Mahajan A, Pietsch T, Thall P, Wolff JE, Wolff JE, Thall P, Pfister S, Rytting M, Bingham R, Vats T, Rokes C, Mahajan A, Brown R, Creach KM, Rubin JB, Leonard JR, Limbrick DD, Smyth MD, Dacey RG, Rich KM, Dowling JL, Linette GP, King AA, Michalski JM, Simpson JR, Park TS, Perry A, Mansur DB, Gururangan S, Panandikar AP, Broniscer A, Huang A, Kellie S, Ellison D, Gajjar A, Aguilera D, Goldman S, Tomita T, Fangusaro J, Gururangan S, Fangusaro J, Poussaint TY, Onar A, Gilbertson R, Packer R, McClendon R, Friedman H, Boyett J, Broniscer A, Baker JN, Tagen M, Onar-Thomas A, Gilbertson RJ, Davidoff AM, Pai-Panandiker A, Leung W, Chin TK, Stewart CF, Kocak M, Rowland C, Merchant TE, Kaste S, Gajjar A, Allen J, Donahue B, Mathew J, Kretschmar C, Pollack I, Jakacki R, Massimino M, Biassoni V, Gandola L, Ferroli P, Bongarzone I, Spreafico F, Pecori E, Schiavello E, Modena P, Bach F, Potepan P, Slavc I, Peyrl A, Czech T, Haberler C, Dieckmann K, Brown RJ, Dhall G, Marachelian A, Gozali A, Butturini A, Gilles F, Thompson SJ, Gardner S, Finlay JL, Brown RJ, Dhall G, Goldman S, Eisenstat DD, Gilles F, Evans A, Finlay JL. Pediatrics Clinical Research. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Broniscer A, Merchant TE, Hillenbrand C, Patay Z, Chin TK, Onar A, Kaste SC, Gilbertson RJ, Gajjar A. Phase I study of vandetanib (ZD6474) administered during and after irradiation (RT) in children with diffuse intrinsic pontine glioma (DIPG). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10020 Background: Children with DIPG have a dismal prognosis despite use of RT, which is the mainstay of therapy. All chemotherapy regimens used so far demonstrated no benefit. EGFR and VEGFR pathways are considered important in tumorigenesis of DIPG. Methods: We conducted a traditional phase I study combining oral vandetanib (VEGFR-2 and EGFR inhibitor) during and after local RT in children with DIPG. Five dosage levels were tested (50, 65, 85, 110, and 145mg/m2 per day). Vandetanib and RT started on the same day. The first 6 weeks of therapy constituted the dose-limiting toxicity (DLT)-evaluation period. Correlative studies consisted of pharmacokinetic analysis (PK), pharmacodynamic studies in blood, and standard and investigational imaging (before and 1, 3, and 6 weeks after start of therapy). Results: Twenty-one patients were enrolled on study (50 [n = 3], 65 [n = 3], 85 [n = 3], 110 [n = 6], and 145mg/m2 [n = 6]). Two patients experienced DLT consisting of rash/mucositis (level 4) and diarrhea (level 5). The maximum-tolerated dose (MTD) of vandetanib was not reached. Other significant toxicities included lymphopenia grade 3/4 (n = 10), grade 3 neutropenia and hypophosphatemia (one each), grade 2 proteinuria (n = 2), grade 2 hypertension (n = 4), and mild QTc prolongation (n = 7) .Once the phase I component was completed, two extra patients were enrolled at dosage level 5; one of them developed grade 4 seizure secondary to posterior reversible encephalopathy syndrome. PK (n = 21) showed similar drug clearance and volume of distribution compared to adults. However, drug exposure at steady state normalized by dose seemed higher in children. Increased tumor perfusion during the first 6 weeks of therapy was observed in the first 12 patients analyzed. Conclusions: Although MTD was not reached, we recommend administration of vandetanib at a dose of 110mg/m2 per day during and after local RT in children. Further combination studies of vandetanib in children with DIPG are planned. No significant financial relationships to disclose.
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Affiliation(s)
- A. Broniscer
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - T. E. Merchant
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - C. Hillenbrand
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - Z. Patay
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - T. K. Chin
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - A. Onar
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - S. C. Kaste
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - R. J. Gilbertson
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - A. Gajjar
- St. Jude Children's Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
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Sanders RP, Onar A, Boyett JM, Broniscer A, Fouladi M, Boop FA, Sanford RA, Kun LE, Merchant TM, Gajjar A. M1 medulloblastoma should be considered high risk at any age. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2016 Background: Metastatic (M) stage is an important prognostic marker in medulloblastoma. With current therapy including higher-dose craniospinal irradiation and dose intensive chemotherapy, older children with metastatic medulloblastoma have had improved survival. Some investigators have suggested that older children with M1 medulloblastoma be treated as average-risk patients. Additionally, the prognostic value of M1 disease in very young children has not been documented. Methods: We retrospectively reviewed the records of all newly diagnosed medulloblastoma patients treated at St. Jude Children’s Research Hospital from 1984 to 2006. Treatment generally included resection and chemotherapy. Older children received post-operative craniospinal and tumor bed irradiation; radiotherapy for younger children depended on treatment era and physician/family preference. We compared event-free and overall survival for patients with M1 disease to that of patients with M0 and M2/M3 disease for both age groups using the Kaplan-Meier method. Results: 286 patients were included. 56 were <3 years old at diagnosis and 230 were =3 years old. Event-free (EFS) and overall survival (OS) by age and M-stage are reported below. Within the younger group, a significant difference in 5-year EFS was detected among M-stage groups (p<0.002 by Mantel-Haenszel test); 5-year EFS for M0 (n=33), M1 (n=5), and M2/M3 (n=18) patients was 67%, 20%, and 22%, respectively. The difference in 5-year EFS by M-stage was also significant for older patients (p<0.0001); 5-year EFS for 154 M0, 13 M1, and 63 M2/M3 patients was 82%, 59%, and 42%, respectively. Results were similar for OS; differences in OS were significant for older (p<0.0001), but not younger (p=0.21) children. Conclusions: Children <3 years old with M1 medulloblastoma fared poorly in our small series. Survival for older children with M1 disease treated with higher-dose CSI was better than that of M2/M3 patients, but still less than optimal; our findings do not support reduction in therapy for either cohort. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- R. P. Sanders
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - A. Onar
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - J. M. Boyett
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - A. Broniscer
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - M. Fouladi
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - F. A. Boop
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - R. A. Sanford
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - L. E. Kun
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - T. M. Merchant
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
| | - A. Gajjar
- St. Jude Childrens Research Hospital, Memphis, TN; University of Tennessee, Memphis, TN
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