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Volume 17, Number 1, 2012

Reirradiation of relapsed brain tumors in children

Marzanna Chojnacka, Anna Skowrońska-Gardas, Katarzyna Pędziwiatr, Marzena Morawska-Kaczyńska, Marta Perek, Danuta Perek

Summary:

Aim: The aim of this study was to evaluate toxicity and response to fractionated reirradiation
(FR) of relapsed primary brain tumors in children.
Background: The treatment options for recurrent brain tumors in children previously irradi-
ated are limited. Reirradiation is performed with fear due to the cumulative late CNS toxicity
and the lack of a significant chance of cure.
Materials and methods: Between 2008 and 2009, eight children with a median age of 14.5
years with a diagnosis of a recurrent brain tumor underwent reirradiation. Initially, all
patients were treated with surgery, chemotherapy and radiotherapy. The median time to
the first recurrence after the initial treatment was 19.5 months. Intervals between radio-
therapy courses were in the range of 5–51 mos. All retreatments were carried out with
3D image-based conformal methods. The total prescription dose was 40 Gy in a fraction
of 5×2 Gy/week. The total cumulative dose ranged from 65 to 95 Gy (median: 75 Gy). The
median cumulative biologically effective dose was 144 Gy (range: 126–181 Gy).
Results: The median overall survival and progression free survival measured from the begin-
ning of reirradiation was 17.5 and 6.5 months, respectively. During the first evaluation, four
patients showed a complete or partial response, two did not respond radiologically. Two
children were progressive at the time of reirradiation. Among children with progression
that occurred during the first year after reirradiation, only two progressed in the treatment
area. The repeated irradiation was well tolerated by all patients. No late complications have
been observed.
Conclusion: In the absence of other treatment possibilities, the fractionated reirradiation
with highly conformal three-dimensional planning could be a therapeutic choice in case of
recurrent brain tumors in children. The control of craniospinal dissemination remains to be
the main problem.

Signature: Rep Pract Oncol Radiother, 2012; 17(1) : 32-37


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http://www.sciencedirect.com/science/journal/15071367/19/2