(P047) Dosimetric and Toxicity Analyses of Reirradiation for Recurrent Pediatric Brain Tumors

Publication
Article
OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

Repeat radiation for recurrent brain tumors may be performed in the pediatric population with acceptable short- and long-term toxicity. Establishment of dose-volume guidelines will facilitate treatment planning for these challenging cases.

Benjamin Farnia, BA, Rola H. Georges, BS, CMD, Matthew Palmer, MBA, CMD, Jinzhong Yang, PhD, Anita Mahajan, MD, Susan L. McGovern, MD, PhD; UT MD Anderson Cancer Center

Background: Reirradiation is increasingly used to treat recurrent pediatric brain tumors, but data-driven dose-volume constraints for repeat radiation are lacking.

Methods: Records of 12 pediatric patients treated with reirradiation for recurrent brain tumors between July 2009 and May 2013 at MD Anderson Cancer Center were retrospectively reviewed for toxicity and outcomes. To determine dosimetric parameters, Digital Imaging and Communications in Medicine (DICOM) datasets of the initial and repeat radiation plans were deformed and merged to determine the maximum dose to 0.03 cc of the optic chiasm, optic nerves, spinal cord, brainstem, cochleae, pituitary, and normal brain and to 1 cc of the brainstem on the individual and composite plans.

Results: Median follow-up was 3.5 years. Median age at initial radiation was 4.5 years and 6.7 years at repeat radiation. Patients had medulloblastoma (n = 4), primitive neuroectodermal tumor (PNET) (n = 2), anaplastic ependymoma (n = 2), or other tumors (n = 4). All patients initially received proton radiotherapy to a median dose of 55.8 cobalt grey equivalent (CGE). At recurrence, patients were treated with intensity-modulated radiation therapy (IMRT) (n = 6), proton (n = 5), or both (n = 1) to a median total dose of 42.5 CGE. All patients completed the planned second course of radiation. At last follow-up, four patients were alive with disease, five were dead, and three had no evidence of disease. No patient developed radiation necrosis. Two patients developed optic pathway defects, likely related to tumor progression. Four patients developed secondary hypothyroidism (median composite maximum dose of 36 CGE to pituitary), and one patient developed growth hormone deficiency (composite maximum dose of 39 CGE to pituitary).

Conclusion: Repeat radiation for recurrent brain tumors may be performed in the pediatric population with acceptable short- and long-term toxicity. Establishment of dose-volume guidelines will facilitate treatment planning for these challenging cases.

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(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment

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