Stereotactic radiosurgery for recurrent pediatric brain tumors: clinical outcomes and toxicity

Author:

Wang Elyn1,Gutkin Paulina M.1,Oh Justin1,Pollom Erqi1,Soltys Scott G.1,Grant Gerald A.2,Prolo Laura M.2,Chang Steven2,Li Gordon2,Fisher Paul G.3,Partap Sonia3,Campen Cynthia J.3,Gibbs Iris C.1,Hiniker Susan M.1

Affiliation:

1. Department of Radiation Oncology, Stanford University, Stanford;

2. Department of Neurosurgery, Stanford University, Stanford; and

3. Department of Neurology and Neurological Sciences, Stanford University, Stanford, California

Abstract

OBJECTIVE Recurrence of brain tumors in children after the initial course of treatment remains a problem. This study evaluated the efficacy and safety of reirradiation using stereotactic radiosurgery (SRS) in patients with recurrent pediatric primary brain tumors. METHODS This IRB-approved retrospective review included pediatric patients with recurrent primary brain tumors treated at Stanford University from 2000 to 2019 using frameless SRS. Time to local failure (LF) and distant intracranial failure (DIF) were measured from the date of SRS and analyzed using competing risk analysis. Overall survival (OS) and progression-free survival (PFS) were analyzed with the Kaplan-Meier method. RESULTS In total, 37 patients aged 2–24 years (median age 11 years at recurrence) were treated for 48 intracranial tumors. Ependymoma (38%) and medulloblastoma (22%) were the most common tumor types. The median (range) single fraction equivalent dose of SRS was 16.4 (12–24) Gy. The median (range) follow-up time was 22.9 (1.5–190) months. The median OS of all patients was 36.8 months. Eight of 40 (20%) lesions with follow-up imaging locally recurred. The 2-year cumulative incidence of LF after reirradiation with SRS was 12.8% (95% CI 4.6%–25.4%). The 2-year cumulative incidence of DIF was 25.3% (95% CI 12.9%–39.8%). The median PFS was 18 months (95% CI 8.9–44). Five (10.4%) patients developed toxicities potentially attributed to SRS, including cognitive effects and necrosis. CONCLUSIONS Reirradiation using SRS for recurrent pediatric brain tumors appears safe with good local control. Innovations that improve overall disease control should continue because survival outcomes after relapse remain poor.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Neurology (clinical),General Medicine,Surgery

Reference20 articles.

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