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Objective To compare the dosimetric characteristics of the methods of volumetric modulated arc therapy ( VMAT ) for craniospinal irradiation , and to compare their robustness to the field placement error . Methods Six patients receiving craniospinal irradiation were included. VMAT plans of each patient were optimized with overlap method and gradient-optimization method respectively using Pinnacle 9.8 VMAT treatment planning system. The length of the overlap region was set as 3 and 9 cm, respectively. Then the dose distributions under different VMAT programs were measured. Moreover, a 3 mm placement error was introduced, and the dose cold spot in the field junction region obtained by each plan was compared for robustness analysis. Results Under different overlapping lengths, the overlap method and the gradient optimization method both can optimize the VMAT plan that meeting the clinical requirements. In the field junction region, the dose distribution obtained by the overlap method was more uniform, and the difference in the uniformity index was statistically significant. When introducing a 3 mm placement error, the gradient optimization method obtained the most robust VMAT plan at 9 cm overlap length, and the overlap method could not obtained stabilized robust plan. Conclusions For the optimization of craniospinal irradiation VMAT plan, the commonly used overlap method can obtain a better dose distribution, but it can't improve robustness by increasing overlap length. However, using the gradient optimization method, the dose homogeneity in the field junction region is not good as the overlap method, but the plan robustness can be improved by increasing the overlap length.
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PURPOSE: We investigated the clinical characteristics of patients who developed thyroid dysfunction and evaluated the risk factors for hypothyroidism following radiotherapy and chemotherapy in pediatric patients with medulloblastoma or primitive neuroectodermal tumor (PNET). METHODS: The medical records of 66 patients (42 males) treated for medulloblastoma (n=56) or PNET (n=10) in childhood between January 2000 and December 2014 at Seoul National University Children’s Hospital were retrospectively reviewed. A total of 21 patients (18 high-risk medulloblastoma and 3 PNET) underwent high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) RESULTS: During the median 7.6 years of follow-up, 49 patients (74%) developed transient (n=12) or permanent (n=37) hypothyroidism at a median 3.8 years of follow-up (2.9–4.6 years). Younger age ( < 5 years) at radiation exposure (P=0.014 vs. ≥9 years) and HDCT (P=0.042) were significantly predictive for hypothyroidism based on log-rank test. However, sex, type of tumor, and dose of craniospinal irradiation (less vs. more than 23.4 Gy) were not significant predictors. Cox proportional hazard model showed that both younger age (< 5 years) at radiation exposure (hazard ratio [HR], 3.1; vs. ≥9 years; P=0.004) and HDCT (HR, 2.4; P=0.010) were significant predictors of hypothyroidism. CONCLUSIONS: Three-quarters of patients with pediatric medulloblastoma or PNET showed thyroid dysfunction, and over half had permanent thyroid dysfunction. Thus, frequent monitoring of thyroid function is mandatory in all patients treated for medulloblastoma or PNET, especially, in very young patients and/or high-risk patients recommended for HDCT/ASCR.
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Humans , Craniospinal Irradiation , Drug Therapy , Follow-Up Studies , Hypothyroidism , Medical Records , Medulloblastoma , Neuroectodermal Tumors, Primitive , Pediatrics , Proportional Hazards Models , Radiation Exposure , Radiotherapy , Retrospective Studies , Risk Factors , Seoul , Stem Cells , Thyroid Gland , Thyroid HormonesABSTRACT
Objective To explore the feasibility and safety of integrated intensity-modulated radiation therapy (IMRT) technology applied in craniospinal irradiation in a supine position. Methods The patients were fixed in a supine position using thermoplastic mask and vacuum mat. Three isocenters with a fixed interval of 20-25 cm were adopted according to the height of patients. A total of 13 beams with a length of 2-3 cm in the overlapping region were included in the treatment plan. Fixed jaw technique was employed and overall calculation was performed by the inverse optimization method. The γ-passing rate and absolute point dose verification were performed for three isocenters and two overlapping regions. Cone-beam CT (CBCT) images were scanned for three isocenters before treatment. The setup error of each isocenter in the x,y and z directions of the same coordinate system was recorded and overall analysis was conducted. Results Among 28 patients,the γ-passing rate (%) of three isocenters and two overlapping regions was 99. 36%, 99. 60%,99. 75%,94. 77% and 95. 09%,whereas the absolute point dose verification error was 1. 56%,-1. 56%,0. 52%,-0. 76% and -1. 68%,respectively. Twenty-eight patients received 162 groups of IGRT with 486 setup errors from the CBCT images. The average deviation in the x, y and z direction for three isocenters (neck,chest and abdomen) was 0. 17 mm,0. 10 mm,0. 02 mm,0. 06 mm,0. 04 mm,0. 46 mm, 0. 19 mm, 0. 26 mm and 0. 41 mm, respectively. Conclusions The integrated IMRT techniques for craniospinal irradiation in a supine position is feasible and safe,which is worthy of clinical application.
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Objective To investigate the dosimetric characteristics between helical tomotherapy ( HT) and intensity-modulated radiotherapy ( IMRT) plans in children receiving craniospinal irradiation and estimate the risk of radiogenic second cancer according to the excess absolute risk ( EAR) model. Methods Computer-tomography scans of 15 children who received craniospinal irradiation between 2012 and 2017 were selected. HT and IMRT plans were designed for each patient after contouring the volumes of tumors and organ at risks ( OARs) and then the homogeneous index ( HI) , conformity index ( CI) , the maximum dose and the mean dose of OAR,V10 and V20 were analyzed to optimize the clinical treatment plan. The second cancer risk was estimated by DVH of each organ and EAR model and statistically compared between HT and IMRT. Results Both two plans met the clinical requirements in target coverage ( 100％ dose≥95％ target volume).The HI in the HT group was significantly superior to that in the IMRT group (P=0. 000) whereas no significant difference was noted in CI between two groups. Compared with the IMRT plan, HT plan possessed absolute advantage in protecting hippocampus and the D2％ and Dmean were significantly lower ( P=0. 000).As for the protection of OAR, the Dmax, Dmean and V20 of thyroid (P=0. 001,0. 002 and 0. 014) and Dmax,V10 of heart ( P=0. 001 and 0. 003) in the HT plan were significantly lower than those in the IMRT plan. In terms of second cancer risk, HT plan yielded a significantly higher second cancer risk for thyroid and lung compared with IMRT the EAR in thyroid was 28. 666 vs. 26. 926 ( P=0. 010 ) and 20. 496 vs. 18.922( P=0. 003) in lung. Both plans yielded a relatively high second cancer risk for stomach ( P=0. 248), whereas a low second cancer risk for liver (P=0. 020). Conclusions HT plan is superior to IMRT plan in the hippocampus-sparing craniospinal irradiation in children. However, HT plan yields a high second cancer risk for thyroid and lung. Consequently, the balance between the carcinogenic risk and the effect on other normal tissues should be assessed in the establishment of therapeutic plan.
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Objective To analyze the relationship between the dose volume of bone marrow and acute hematologic toxicity in craniospinal irradiation (CSI),and preliminarily explore the dosimetric differences in bone marrow between helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT).Methods Clinical data and HT plans of twenty patients treated with CSI in the First Affiliated Hospital of Kunming Medical University were collected,and the HT plans were transferred back to the MIM system.The skull,mandible,clavicle,sternum,scapula,ribs,vertebrae and pelvis were successively delineated on the CT images and then the V2,V5,V10,V15,V20,V25,V30,V35,Dmax Dmean of each aforementioned bone and total bone were read on DVH images.The correlation between those indexes and the incidence of ≥ grade Ⅱ hematologic toxicity was subsequently analyzed.The images of 6 patients were selected and transferred to Monaco TPS and VMAT plans were completed.The dosimetric differences of those indexes were statistically compared between HT and VMAT.Statistical analyses were performed by using Spearman correlation analysis and Wilcoxon symbol rank-sum test.Results The incidence of ≥ grade Ⅱ leukopenia was positively correlated with the V25 of pelvis and the V5 of total bones (P =0.038);the risk of ≥ grade Ⅱ thrombocytopenia was positive associated with the V20 of pelvis (P=0.041);the incidence of ≥grade Ⅱ neutropenia was positively correlated with the V10 of vertebrae (P=O.036).There was no dosimetric difference of dose volume of vertebral and pelvis between HT and VMAT plans (P＞ 0.05).Conclusions There is a positive correlation between ≥ grade Ⅱ leukopenia and the V25 of pelvis and the V5 of total bones.The V20 of pelvis shows a positive correlation with ≥ grade Ⅱ thrombocytopenia.A positive correlation is found between ≥ grade Ⅱ neutropenia and the V10 of vertebrae.The indices of vertebral and pelvis between HT and VMAT plans show no significant differences.
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Objective@#To evaluate the clinical efficacy and adverse events of recombinant human interleukin-11(rhIL-11) in the prevention of thrombocytopenia induced by craniospinal irradiation.@*Methods@#In this randomized control study, 100 patients were randomly divided into A (rhIL-11 group, n=50) and B groups (control group, n=50). In the A group, subcutaneous injection of rhIL-11 was delivered at a dose of 50 μg/kg/d, once daily when the platelet count was< 100×109/L during radiotherapy or decreased by> 50% compared with the baseline level. The administration of rhIL-11 was terminated when the platelet count was ≥ 200×109/L. In the B group, the same protocol was conducted when the platelet count was< 50×109/L and terminated until the platelet count was ≥ 100×109/L. The clinical efficacy was assessed in 92 patients. Subcutaneous injection of rhIL-11 could significantly elevate the minimal platelet count during craniospinal irradiation (P<0.01), considerably shorten the duration of thrombocytopenia (P<0.01) and effectively shorten the duration of radiotherapy (P<0.01). Main adverse events included mild pain at the injection site, sclerosis, redness and fatigue, etc.@*Conclusions@#Injection of rhIL-11 can significantly enhance the platelet count, effectively reduce the incidence of thrombocytopenia throughout craniospinal irradiation, guarantee the success of radiotherapy and yield mild adverse events.
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Objective To investigate the early diagnosis and treatment of craniospinal irradiation(CSI)in-duced lung injury (RILI)in children with malignant brain tumors.Methods From January 2014 to January 2016,a total of 145 children with malignant brain tumors from Beijing Shijitan Hospital,Capital Medical University were enrolled in this study.All children received postoperative CSI.Ten children were diagnosed as RILI by high－resolution computed tomography (HRCT)scanning before the start of subsequent chemotherapy and 42 days after CSI.Oral Pred-nisone acetate tablets 0.5－1.0 mg/(kg·d)were given to treat RILI and compound Sulfamethoxazole to prevent sec-ondary lung inflammation.Antibiotic treatment and symptomatic support were given to 2 patients because of the com-bined infection.Then every 4 weeks HRCT was performed and the dosage of Prednisone was adjusted.Clinical charac-teristics and treatment effects were observed synthetically.Results Up to January 2018,the median follow－up time was 28 months (ranged from 26 to 48 months),only 10 patients suffered from RILI,and the morbidity was 6.9%.Eight of 10 patients had medulloblastoma,1 case with pineoblastoma,and 1 case with atypical teratoma/rhabdomyoid tumor. They were 6 boys and 4 girls,and the median age was 8 years old (ranged from 5 to 13 years old).The time points of diagnosis of lung damage were 39－52 days after the end of radiotherapy,and lesions were located in the dorsal or basal segments of lower lobe of unilateral or bilateral lung in HRCT scanning.No obvious respiratory symptoms or other dis-comfort was found except for frequent cough in 2 patients.Lung lesions were gradually reduced and disappeared within 2 to 8 months after treatment with Prednisone and compound Sulfamethoxazole.Two cases suffered severe infection be-fore or during the subsequent chemotherapy,and the condition was gradually improved after anti－infection treatment based on drug sensitivity test.Then subsequent chemotherapy underwent successfully.Conclusions RILI presents mild symptoms or asymptomatic.Routine lung imaging after radiotherapy is beneficial to the early diagnosis of lung damage, and early treatment with Prednisone and prophylaxis with compound Sulfamethoxazole has a good prognosis.
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Objective To compare the effective dose deposited in patients between helical tomotherapy (HT) and multi-ISO radiotherapy (M-ISO) in carniospinal irradiation (CSI).Methods Nine children with craniospinal irradiation were selected .For these patients , new plans were designed with HT and M-ISO centers planning method on the treatment planning system ( TPS) .The effective dose of the nine patients from 18 treatment plans were calculated ,and the difference of the effective dose between HT and M-ISO was compared using paired t-test.Results The plans designed in two groups were both satisfied all clinical requirements .For the planning target volume ( PTV ) , no statistically significant difference was found in D95% between two groups ( P>0.05 ) , while D98%, D2% and homogeneity index (HI) in HT group were superior to M-ISO group (t=2.762, 2.413, 4.563, P<0.05), D50%, Dmean and CI in M-ISO group were superior to HT group (t=5.259, 3.685, 7.815, P<0.05).HT and M-ISO had different advantages in the protection of the OARs .The effective dose of patients in M-ISO group was superior to HT group (t=5.921, P<0.05).Conclusions HT and M-ISO have different advantages in CSI.The low dose area has greater influence on the effective dose in HT group compared to M-ISO group. The low dose area should be concerned while designing the treatment planning for CSI .
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Objective To evaluate the hematological toxicity of craniospinal irradiation,and determine the short-term clinical efficacy and prognostic factors in medulloblastoma.Methods Eightseven patients who underwent craniospinal irradiation were retrospectively analyzed with respect to the changes in hematology during craniospinal irradiation.The effect of sex,age,tumor location,interval between surgery and radiation,interval time during radiation and radiation sequence on survival were also studied.Results The 1,2,3-year overall survival (OS) and progress-free survival (PFS) rate were 95.0％,92.4％,84.9％ and 93.7％,89.8％,80.8％,respectively.The incidence of 2-3 grade leucopenia was 90.8％,while the incidence of 1-2 grade thrombocytopenia was 70.1％,and the incidence of 3 grade thrombocytopenia was 1.1％.The incidence of 1-2 grade hemoglobin reduction was 16.1％.No patient had grade 3-4 hemoglobin reduction.Kaplan-Meier analysis shows that more favorable prognoses in terms of 3-year PFS were evident for 0-1 grade thrombocytopenia compared with 2-4 grade thrombocytopenia (x2 =3.936,P ＜ 0.05).And 3-year PFS and 3-year OS were evident for 0 grade hemoglobin reduction compared with 1-4 grade hemoglobin reduction (x2 =10.269,9.336,P ＜ 0.05).The 3-year PFS between interval time during radiation ＜ 3 days and ≥ 3 days was 84.6％ and 68.6％ (x2 =4.413,P ＜ 0.05).Conclusions Hematological toxicity during craniospinal irradiation and the interval time during radiation were prognostic factors.
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Objective To investigate the treatment outcomes of 41 patients with suprasellar and pineal germinoma who are treated in our department in recent 18 years,and to explore related therapeutic strategies.Methods A total of 41 patients with concurrent suprasellar and pineal germinoma who were treated in our department from January 1996 to August 2013 were enrolled.There were 35 male patients and 6 female patients,and the median age was 16 years (range 5-39 years).Five patients had pathologically confirmed germinoma and 36 patients had clinically diagnosed germinoma.Conventional radiotherapy was performed for 33 patients, and intensity-modulated radiotherapy was performed for 8 patients.Combined-modality chemoradiotherapy was performed for the 5 patients with pathologically diagnosed germinoma.The 6 MV X-ray was applied for radiotherapy;6 patients received whole ventricular irradiation and a boost in tumor region, 16 received whole-brain radiotherapy and a boost in tumor region,and 19 received craniospinal irradiation and a boost in tumor region.The median radiation dose for tumor region was 45.0 Gy (37.8-50.0 Gy),and the median dose for prophylactic irradiation was 25.0 Gy (17.8-35.0 Gy).The survival was caculated using Kaplan-Meier method.Results The number of patients followed were 26 at 5-years.The 5-year overall survival rate and relapse-free survival rate were 95% and 85%,respectively.Relapse and metastasis were noted in 8 patients,and 3 of them died.There were 4 patients with spinal cord metastasis,1 patient with ventricular dissemination,and 3 patients with periventricular relapse.Among the 22 patients who did not undergo spinal irradiation,4(18.2%) experienced spinal cord metastasis,and all the other 19 patients who underwent spinal irradiation did not experience spinal cord metastasis.The 8 patients undergoing intensity-modulated radiotherapy and the 5 patients undergoing combined-modality chemoradiotherapy did not experience treatment failure during follow-up.Conclusions Radiotherapy for intracranial germinoma has a good therapeutic effect,and the patients with suprasellar and pineal germinoma who do not undergo spinal cord irradiation have a high failure rate.It is suggested to perform spinal cord irradiation for patients with suprasellar and pineal lesions.
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objective:To investigate the clinical features and prognosis of pinealoblastoma in children. Methods:The clinical data of 10 patients with pinealoblastoma were retrospectively analyzed. These patients were admitted to the Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University from December 2011 to December 2015. Results:This study included 10 patients, with 8 males and 2 females, with a median age of 7 years. Of the 10 patients, 5 underwent gross total resection and 5 underwent sub-total resection. The 10 patients were exposed to craniospinal irradiation after surgery. The median doses of craniospinal irradiation and tumor bed were 30.6 (25.5-36) Gy and 55.8 (50.4-60) Gy, respectively. Of the 10 patients, 4 underwent chemotherapy 1 month af-ter radiotherapy. The median follow-up period was 16.5 (1.5-49) months. The 10 patients survived. No local and distant recurrences were observed. Conclusion:Pinealoblastomas are rare, malignant, and pineal regional lesions that can metastasize along the neuroax-is. Surgery combined with adjuvant radiotherapy and chemotherapy should be applied to patients with pinealoblastoma. Prognosis is also favorable.
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PURPOSE: The purpose of this study is to investigate the long-term results and appropriateness of radiation therapy (RT) for medulloblastoma (MB) at a single institution. MATERIALS AND METHODS: We analyzed the clinical outcomes of 106 patients with MB who received RT between January 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), and the proportion of M0, M1, M2, and M3 stages was 60.4%, 8.5%, 4.7%, and 22.6%, respectively. The median total craniospinal irradiation (CSI) and posterior fossa tumor bed dose in 102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. RESULTS: The median follow-up period in survivors was 132 months (range, 31 to 248 months). A gradual improvement in survival outcomes was observed, with 5-year overall survival rates of 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developed at the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossa other than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinal subarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Although the frequency of posterior fossa/tumor bed recurrences was significantly high among patients treated with subtotal resection, other site (other intracranial/spinal) recurrences were more common among patients treated with gross tumor removal (p=0.016). There was no case of spinal subarachnoid space relapse from desmoplastic/extensive nodular histological subtypes. CONCLUSION: Long-term follow-up results and patterns of failure confirmed the importance of optimal RT dose and field arrangement. More tailored multimodal strategies and proper CSI technique may be the cornerstones for improving treatment outcomes in MB patients.
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Humans , Combined Modality Therapy , Craniospinal Irradiation , Follow-Up Studies , Infratentorial Neoplasms , Medulloblastoma , Radiotherapy , Recurrence , Subarachnoid Space , Survival Rate , SurvivorsABSTRACT
PURPOSE: In order to perform craniospinal irradiation (CSI) in the supine position on patients who are unable to lie in the prone position, a new simulation technique using a CT simulator was developed and its availability was evaluated. MATERIALS AND METHODS: A CT simulator and a 3-D conformal treatment planning system were used to develop CSI in the supine position. The head and neck were immobilized with a thermoplastic mask in the supine position and the entire body was immobilized with a Vac-Loc. A volumetric image was then obtained using the CT simulator. In order to improve the reproducibility of the patients' setup, datum lines and points were marked on the head and the body. Virtual fluoroscopy was performed with the removal of visual obstacles such as the treatment table or the immobilization devices. After the virtual simulation, the treatment isocenters of each field were marked on the body and the immobilization devices at the conventional simulation room. Each treatment field was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR)/digitally composite radiography (DCR) images from the virtual simulation. The port verification films from the first treatment were also compared with the DRR/DCR images for a geometrical verification. RESULTS: CSI in the supine position was successfully performed in 9 patients. It required less than 20 minutes to construct the immobilization device and to obtain the whole body volumetric images. This made it possible to not only reduce the patients' inconvenience, but also to eliminate the position change variables during the long conventional simulation process. In addition, by obtaining the CT volumetric image, critical organs, such as the eyeballs and spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. The differences between the DRRs and the portal films were less than 3 mm in the vertebral contour. CONCLUSION: CSI in the supine position is feasible in patients who cannot lie on prone position, such as pediatric patients under the age of 4 years, patients with a poor general condition, or patients with a tracheostomy.
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Humans , Craniospinal Irradiation , Fluoroscopy , Head , Immobilization , Masks , Neck , Prone Position , Radiography , Spinal Cord , Supine Position , TracheostomyABSTRACT
PURPOSE: Intracranial germinoma is the most radiocurable tumor of the primary intracranial neoplasm. But, the optimum radiation dose and target volume remain controversial. In this retrospective study, we analysed the spreading pattern at presentation and the pattern of the failure and survival of intracranial germinoma. MATERIALS AND METHODS: From 1989 to 1996, 23 patients were treated for intracranial germinoma at Department of Radiation Oncology. Twenty-one patients were treated at their initial presentation and 2 patients were treated for recurrent disease. Six patients had multiple tumor masses on MRI and 7 patients had ventricular seeding on MRI. The examination of cerebrospinal fluid cytology was done in 15 patients and 3 out of 15 patients had positive cerebrospinal cytology. In tumor marker study of alpha-FP and beta-hCG, 6 patients had mildly elevated beta-hCG in serum or cerebrospinal fluid. Twenty-one patients were treated with whole craniospinal axis irradiation and 2 patients were given whole ventricular radiation therapy. The total dose was ranged between 4500cGy and 5600cGy to primary tumor site (median 5580 cGy). Dose to the entire ventricular system ranged from 1980cGy to 3960 cGy (median 2700cGy) and dose to the spinal axis ranged from 2160cGy to 3900cGy (median 2700cGy). RESULTS: Of 23 patients, 21 patients are alive without evidence of disease for median 4 years follow-up. One patient who had markedly elevated alpha-FP and beta-hCG suffered from persistent disease after radiation therapy and received 2 cycles of chemotherapy. She died 9 months after chemotherapy. One patient who developed ventricular seeding after gamma-knife was treated with whole craniospinal irradiation, he died after 1 year due to probably brain necrosis. The hematologic toxicity of 3 or 4 grade were seen in 7 patients, and patient's endocrinologic dysfunction was not deteriorated after radiation therapy. One patient had been treated with growth hormone replacement due to short stature. CONCLUSIONS: This retrospective study has confirmed the excellent result of radiation therapy in intracranial germinoma. The complication rate during or after radiation therapy is considered within acceptable range. It is necessary to further investigate the optimal dose and treatment volume of radiation therapy. The role of chemotherapy in the treatment of intracranial germinoma should be further investigated.
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Humans , Axis, Cervical Vertebra , Brain , Brain Neoplasms , Cerebrospinal Fluid , Craniospinal Irradiation , Drug Therapy , Follow-Up Studies , Germinoma , Growth Hormone , Magnetic Resonance Imaging , Necrosis , Radiation Oncology , Retrospective StudiesABSTRACT
PURPOSE: To assess the efficacy of craniospinal radiotherapy in patients with acute lymphoblastic leukemia (ALL) experiencing the CNS relapse. MATERIALS AND METHODS: Thirty ALL patients with relapse in the central nervous system(CNS) were treated with radiotherapy and intrathecal chemotherapy. Age ranged 2 to 46. The number of males and females were all 15. Twenty-two cases were previously treated with presymptomatic radiotherapy to the whole brain. The extent of radiotherapy was the whole brain (18-24 Gy) and the whole spine (12 Gy) in 21 cases but the whole brain only in the 9 cases with poor performance. RESULTS: The complete remission rate in the CNS was 10%. Among the 12 cases(40%) who had secondary relapse, 9 cases had the bone marrow relapse alone, 2 cases had the CNS and bone marrow relapse, 1 case had the CNS relapse alone. Higher CNS remission rate was observed when the initial remission duration was longer than 24 months or radiation was delivered to the whole brain and the whole spine. Survival rate at 2 year was 31.6%. Remission duration in the 10 living patients ranged from 9 to 87 months(median ; 58 months). CONCLUSION: The whole craniospinal area should be included in the radiotherapy port for the effective control of CNS relapse in ALL cases
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Female , Humans , Male , Bone Marrow , Brain , Craniospinal Irradiation , Drug Therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Radiotherapy , Recurrence , Spine , Survival RateABSTRACT
PURPOSE: To assess the efficacy of craniospinal radiotherapy in patients with acute lymphoblastic leukemia (ALL) experiencing the CNS relapse. MATERIALS AND METHODS: Thirty ALL patients with relapse in the central nervous system(CNS) were treated with radiotherapy and intrathecal chemotherapy. Age ranged 2 to 46. The number of males and females were all 15. Twenty-two cases were previously treated with presymptomatic radiotherapy to the whole brain. The extent of radiotherapy was the whole brain (18-24 Gy) and the whole spine (12 Gy) in 21 cases but the whole brain only in the 9 cases with poor performance. RESULTS: The complete remission rate in the CNS was 10%. Among the 12 cases(40%) who had secondary relapse, 9 cases had the bone marrow relapse alone, 2 cases had the CNS and bone marrow relapse, 1 case had the CNS relapse alone. Higher CNS remission rate was observed when the initial remission duration was longer than 24 months or radiation was delivered to the whole brain and the whole spine. Survival rate at 2 year was 31.6%. Remission duration in the 10 living patients ranged from 9 to 87 months(median ; 58 months). CONCLUSION: The whole craniospinal area should be included in the radiotherapy port for the effective control of CNS relapse in ALL cases
Subject(s)
Female , Humans , Male , Bone Marrow , Brain , Craniospinal Irradiation , Drug Therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Radiotherapy , Recurrence , Spine , Survival RateABSTRACT
Between 1988 and 1992, seven patients with overt meningeal leukemia who had received adequate central nervous system (CNS) prophylaxis were treated with intermittent craniospinal irradiation and intrathecal methotrexate(IIIC). Follow-up time ranged from 8 months to 41 months with median of 20 months. Three of 7 patients developed subsequent CNS relapse. CNS remission durations were 8, 9, 13, 20, 28, 34, 36 months from diagnosis of CNS leukemia for which IIIC was given. Disease free survival after CNS relapse ranged from 2 to 36 months with median of 11 months. Overall survival after CNS relapse ranged from 8 to 41 months with median of 28 months. Five patients died of sepsis and bleeding secondary to bone marrow relapse. Two patients are alive at present. But they developed recurrent CNS disease 10 to 11 months after completion of IIIC. To improve the outcome, modification of IIIC by reduction of rest period and prolonged administration of intrathecal chemotherapy after completion of IIIC are required.