- 作者：Tejpal Gupta ; Rakesh Jalali ; Savita Goswami ; Vimoj Nair ; Aliasgar Moiyadi ; Sridhar Epari ; Rajiv Sarin
- 关键词：Medulloblastoma ; Risk stratification ; Hyperfractionated radiotherapy ; Cognition
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：1 August, 2012
- 年：2012
- 卷：83
- 期：5
- 页码：1534-1540
- 全文大小：535 K
Purpose
To report on acute toxicity, longitudinal cognitive function, and early clinical outcomes in children with average-risk medulloblastoma.Methods and Materials
Twenty children ¡Ý5 years of age classified as having average-risk medulloblastoma were accrued on a prospective protocol of hyperfractionated radiation therapy (HFRT) alone. Radiotherapy was delivered with two daily fractions (1 Gy/fraction, 6 to 8 hours apart, 5 days/week), initially to the neuraxis (36 Gy/36 fractions), followed by conformal tumor bed boost (32 Gy/32 fractions) for a total tumor bed dose of 68 Gy/68 fractions over 6 to 7?weeks. Cognitive function was prospectively assessed longitudinally (pretreatment and at specified posttreatment follow-up visits) with the Wechsler Intelligence Scale for Children to give verbal quotient, performance quotient, and full-scale intelligence quotient (FSIQ).
Results
The median age of the study cohort was 8 years (range, 5-14 years), representing a slightly older cohort. Acute hematologic toxicity was mild and self-limiting. Eight (40 % ) children had subnormal intelligence (FSIQ <85), including 3 (15 % ) with mild mental retardation (FSIQ 56-70) even before radiotherapy. Cognitive functioning for all tested domains was preserved in children evaluable at 3 months, 1 year, and 2 years after completion of HFRT, with no significant decline over time. Age at diagnosis or baseline FSIQ did not have a significant impact on longitudinal cognitive function. At a median follow-up time of 33 months (range, 16-58 months), 3 patients had died (2 of relapse and 1 of accidental burns), resulting in 3-year relapse-free survival and overall survival of 83.5 % and 83.2 % , respectively.
Conclusion
HFRT without upfront chemotherapy has an acceptable acute toxicity profile, without an unduly increased risk of relapse, with preserved cognitive functioning in children with average-risk medulloblastoma.