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Erker C, Craig B, Bailey S, Massimino M, Larouche V, L Finlay J, Kline C, Michaiel G, Margol A, Cohen K, Cacciotti C, Harrods V, Doris K, AbdelBaki M, Amayiri N, Wang Z, Hansford J, Hukin J, Salloum R, Hoffman L, Muray J, Ginn K, Zapotocky Z, Baroni L, Ramaswamy V, Gilheens S, Aguiera D, Mazewski C, Shah S, Strother D, Muller S, Gajjar A, Northcott P, Clifford S, Robinson G, Bouffet E, Lafay-Cousin L. MEDB-49. Relapsed SHH medulloblastomas in young children. Are there alternatives to full-dose craniospinal irradiation? Neuro Oncol 2022. [PMCID: PMC9165324 DOI: 10.1093/neuonc/noac079.423] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Simon Bailey
- Great North Children's Hospital , Newcastle , United Kingdom
| | | | - Valerie Larouche
- Centre Hosptitalier Universitaire de Quebec, Quebec City , QC , Canada
| | | | - Cassie Kline
- Children's Hospital of Philadelphia , Philadelphia, PA , USA
| | - George Michaiel
- British Columbia CHildren's Hospital , Vancouver, BC , Canada
| | - Ashley Margol
- Children's Hospital of Los ANgeles, Los Angeless , CA , USA
| | - Kenneth Cohen
- Sidney Kimmel Comprehensive Cancer Center Johns Hopkins , Baltimore, MD , USA
| | - Chantel Cacciotti
- Children’s Hospital, London Health Sciences Centre , London, ON , Canada
| | - Virginia Harrods
- Dell Children's Medical Center of Central Texas , Austin, TX , USA
| | | | | | | | - Zhihong Wang
- Virginia Commonwealth University Massey Cancer Center , Richmond, VA , USA
| | - Jordan Hansford
- Children’s Cancer Centre, Royal Children’s Hospital , Melbourne , Australia
| | - Juliette Hukin
- British Columbia CHildren;s Hospital , Vancouver, BC , Canada
| | | | | | - Jeffrey Muray
- Cook Children's Medical Center, Fort Worth , TX , USA
| | - Kevin Ginn
- Children's Mercy Hospitals and Clinics, Kansas City , MO , USA
| | - Zapotocky Zapotocky
- University Hospital Motol, Prague, Czech RepublicUniversity Hospital Motol , Prague , Czech Republic
| | - Lorena Baroni
- Hospital of Pediatrics SAMIC Prof. Dr Juan P. Garrahan , Bueno Aeres , Argentina
| | | | | | - Dolli Aguiera
- Children’s Health Care of Atlanta, Emory University , Atlanta, GA , USA
| | - Claire Mazewski
- Children’s Health Care of Atlanta, Emory University , Atlanta, GA , USA
| | - Shafqat Shah
- University of Texas Health Science Center, San Antonio , TX , USA
| | | | - Sabine Muller
- University of California San Francisco, San Francisco , CA , USA
| | - Amar Gajjar
- St Jude Research Hospital , Memphis, TN , USA
| | | | - Steve Clifford
- Wolfson Childhood Cancer Research Centre , Newcastle , United Kingdom
| | | | - Eric Bouffet
- Hospital for Sick Children , Toronto, ON , Canada
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