1.Analysis of the Causes of Subfrontal Recurrence in Medulloblastoma and Its Salvage Treatment.
Jae Ho CHO ; Woong Sub KOOM ; Chang Geol LEE ; Kyoung Ju KIM ; Su Jung SHIM ; Jino BAK ; Kyoungkeun JEONG ; Tae Gon KIM ; Dong Seok KIM ; Joong Uhn CHOI ; Chang Ok SUH
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2004;22(3):165-176
PURPOSE: Firstly, to analyze factors in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma. Secondly, to explore an effective salvage treatment for these relapses. MATERIALS AND METHODS: Two patients who had high-risk disease (T3bM1, T3bM3) were treated with combined chemoradiotherapy. CT-simulation based radiation-treatment planning (RTP) was performed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. RESULTS: Review of radiotherapy portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume. When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. CONCLUSION: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.
Brain
;
Chemoradiotherapy
;
Craniospinal Irradiation
;
Humans
;
Medulloblastoma*
;
Optic Nerve
;
Radiotherapy
;
Recurrence*
2.Long-term results of suppressing thyroid-stimulating hormone during radiotherapy to prevent primary hypothyroidism in medulloblastoma/PNET and Hodgkin lymphoma: a prospective cohort study.
Maura MASSIMINO ; Marta PODDA ; Lorenza GANDOLA ; Emanuele PIGNOLI ; Ettore SEREGNI ; Carlo MOROSI ; Filippo SPREAFICO ; Andrea FERRARI ; Emilia PECORI ; Monica TERENZIANI
Frontiers of Medicine 2021;15(1):101-107
Primary hypothyroidism commonly occurs after radiotherapy (RT), and coincides with increased circulating thyroid-stimulating hormone (TSH) levels.We tested therefore the protective effect of suppressing TSH with L-thyroxine during RT for medulloblastoma/PNET and Hodgkin lymphoma (HL) in a prospective cohort study. From1998 to 2001, a total of 37 euthyroid children with medulloblastoma/PNET plus 14 with HL, scheduled for craniospinal irradiation and mediastinum/neck radiotherapy, respectively, underwent thyroid ultrasound and free triiodothyronine (FT3), free thyroxine (FT4), and TSH evaluation at the beginning and end of craniospinal iiradiation. From 14 days before and up to the end of radiotherapy, patients were administered L-thyroxine checking every 3 days TSH to ensure a value < 0.3 μIU/mL. During follow-up, blood tests and ultrasound were repeated; primary hypothyroidism was considered an increased TSH level greater than normal range. Twenty-two/37 patients with medulloblastoma/PNET and all the 14 patients with HL were alive after a median 231 months from radiotherapy with 7/22 and 8/14 having correctly reached TSH levels < 0.3 μIU/mL and well matched for other variables. Twenty years on, hypothyroidism-free survival rates differed significantly, being 60% ± 15% and 15.6% ± 8.2% in TSH-suppressed vs. not-TSH suppressed patients, respectively (P = 0.001). These findings suggest that hypothyroidism could be durably prevented in two populations at risk of late RT sequelae, but it should be confirmed in a larger cohort.
Cerebellar Neoplasms
;
Child
;
Hodgkin Disease/radiotherapy*
;
Humans
;
Hypothyroidism/prevention & control*
;
Medulloblastoma/radiotherapy*
;
Prospective Studies
;
Thyrotropin
3.Subfrontal Recurrence of Medulloblastoma after Postoperative Whole Neuroaxis Irradiation.
In Ho PARK ; Shin JUNG ; Jae Hyoo KIM ; Soo Han KIM ; Sam Suk KANG ; Je Hyuk LEE
Journal of Korean Neurosurgical Society 1995;24(1):67-72
The authors report a 12-year-old boy who had developed subfrontal recurrence of a medulloblastoma followed by postoperative whole neuroaxis irradiation. The remission persisted for about 3 years after posterior fossa surgery and radiotherapy. Then the tumor recurred in the frontal base, but local recurrence in the posterior fossa was not observed. Operative removal of the metastasis was carried out and the pathological finding was same as medulloblastoma in the posterior fossa. A pitfall of conventional whole brain radiation port is the base of the anterior cranial fossa. Then the entire subarachnoid space should be included in the postoperative radiation field for the treatment of medulloblstoma.
Brain
;
Child
;
Cranial Fossa, Anterior
;
Humans
;
Male
;
Medulloblastoma*
;
Neoplasm Metastasis
;
Radiotherapy
;
Recurrence*
;
Subarachnoid Space
4.Correspondence regarding "Epidemiology, management and treatment outcome of medulloblastoma in Singapore".
Annals of the Academy of Medicine, Singapore 2007;36(12):1042-author reply 1043
Child
;
Child Welfare
;
Humans
;
Medulloblastoma
;
drug therapy
;
epidemiology
;
surgery
;
Mortality
;
Radiotherapy
;
Singapore
;
epidemiology
;
Treatment Outcome
5.Medulloblastoma with extensive nodularities: report of a case.
Qiu-ping GUI ; Xin SONG ; Huai-yu TONG
Chinese Journal of Pathology 2007;36(9):644-645
Cerebellar Neoplasms
;
diagnosis
;
pathology
;
radiotherapy
;
surgery
;
Follow-Up Studies
;
Humans
;
Infant
;
Magnetic Resonance Imaging
;
Male
;
Medulloblastoma
;
diagnosis
;
pathology
;
radiotherapy
;
surgery
6.Influence of Prognostic Factors on Survival Rate of Medulloblastoma Patient with Chemotherapy.
Kyung Mi SHIN ; Sung Yeon CHOI ; Sung Chul WON ; Chang Hyun YANG ; Chuhl Joo LYU ; Chang Ok SUH ; Joong Uhn CHOI ; Byung Soo KIM
Journal of the Korean Pediatric Society 2003;46(2):178-182
PURPOSE: Brain tumors are the second most common tumor in childhood, and medulloblastomas comprise 15-25% of brain tumors. The well known prognostic factors are age at diagnosis, stage of disease, and extent of surgical excision. In this study, we analysed the prognostic factors in patients who received chemotherapy after excision. METHODS: We reviewed the medical records of 61 patients who received chemotherapy among the 94 patients who were diagnosed and treated between Jan 1985 and Sep 2001 in the Department of Pediatrics and Neurosurgery at Severance Hospital. RESULTS: Among the total survival rate of patients who underwent chemotherapy, the 3-yr progression-free survival rate was 66.5+/-6.3% and the 15-yr progression-free survival rate was 60.3+/-6.7%. The progression-free survival rate for patients with age at diagnosis over 3 yrs old and under 3 yrs old, was 64.5+/-7.7% and 48.2+/-12.9% respectively and there was no statistically significant difference. The survival rate of the high vs low risk group by staging was 72.7+/-10.5% and 54.6+/-8.3% respectively, and there was no significant difference. The survival rate of patients with total removal vs subtotal removal was 65.8+/-11.8% and 56.8+/-8.2% respectively, showing no statistical difference. CONCLUSION: The reason there is no difference in survival rate according to the traditional prognostic factors is that chemotherapy has improved not only the total survival rate but also the survival rate in patients with poor traditional prognostic factors. So, sufficient removal of tumor followed by proper chemotherapy and radiotherapy is an important factor which influences the survival rate of medulloblastoma patients.
Brain Neoplasms
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Diagnosis
;
Disease-Free Survival
;
Drug Therapy*
;
Humans
;
Medical Records
;
Medulloblastoma*
;
Neurosurgery
;
Pediatrics
;
Radiotherapy
;
Survival Rate*
7.Roles of BRW CT Stereotaxic in Less Accessible Brain Lesions.
Jowa Hyuk IHM ; Yong Chul CHI ; Byung Yeran CHOI ; Choong Bae MOON ; Soo Ho CHO
Journal of Korean Neurosurgical Society 1986;15(4):635-650
With improvement of computerized tomography(CT), stereotaxic surgery has been applied for neurosurgery ; aspiration of deep-seated brain lesions, radiotherapy using a small radiogenic sources, and evacuation of hematoma. And so, a prototype Brown-Roberts-Wells(BRW) CT stereotaxic system has been avaible to us. We report its utilization in evaluation and management of less accessible brain lesions. Surgical exploration was undertaken in 25 patients with various less accessible brain lesions using BRW system : 9 superficial lesions including the motor cortex and multiple lesions, 5 deep-seated lesions, 3 parasellar lesions, 8 brain stem lesions. Histologically, there are 5 gliomas, 4 metastatic cancers, 8 hematomas, 3 brain abscesses, 1 medulloblastoma, 1 malignant melanoma, 1 cryptic AVM, and 2 undiagnosed cases. There are two complications : 1 intratumoral bleeing, 1 rebleeding. The diagnostic rate is 92%. There is no mortality in this series. This BRW CT-guidance stereotaxic approach for less accessible lesions have following advantages ; 1) accurate, simple and safe ; 2) performed under local anesthesia ; 3) less traumatic and low cost ; 4) easily diagnosed ; 5) relatively no limitation in lesion sites.
Anesthesia, Local
;
Brain Abscess
;
Brain Stem
;
Brain*
;
Glioma
;
Hematoma
;
Humans
;
Medulloblastoma
;
Melanoma
;
Mortality
;
Motor Cortex
;
Neurosurgery
;
Radiotherapy
8.Medulloblastoma: Radiotherapy Result with Emphasis on Radiation Dose and Methods of Craniospinal Treatiment.
Il Han KIM ; Sung Whan HA ; Charn Il PARK ; Byung Kyu CHO
Journal of the Korean Society for Therapeutic Radiology 1988;6(2):183-194
Twenty five patients with histologically proven medulloblastoma received craniospinal radiotherapy (CSRT) at the Seoul National University Hospital from 1979 to 1984. The extent of tumor removal was biopsy only in 2 patients, partial in 18, and near total in 5. With orthogonal technique of CSRT, mainly 55 gy was delivered to the posterior fossa(PF). 40gy to whole brain (WB), and 30 gy to whole spine (WS). And with AP : PA technique, 50 gy to PF, 45-50 gy to WB, and 36 gy to WS. Complete remission was obtained in 84% of patients. Among 21 CR's 10 failures were observed, thus total failure rate was 56% (14/25). Of 14 failure 13 had the primary failure, 11 failed in primary site alone, 1 failure was combined with ventricular seeding, and another 1 was combined with neck node metastasis. There was 1 isolated spinal failure. Actuarial overall survival rates at 3 and 5 years were 75% and 54%, and disease-free survival rates were 58% and 36%, respectively. Better 5 year disease-free survival was noted in patients with 55gy to the posterior fossa than those with 50 gy (62% vs 17%, p<0.05), in patients treated with orthogonal technique than those treated with AP : PA technique (87% vs 12%, p<0.05), and in patients with near total removal than those with partial or less removal of tumor (56% vs 30%, N.S.) Re-irradiation was not satisfactory. No severe late sequelae was notede among the survivors. For the higher control of medulloblastoma, dose to posterior fossa should be at least 55 gy with orthogonal CSRT to small tumor burden. And dose reduction in the subarachnoidal space might be safe, but optimal dose to the subarchnoidal space should be determined by the thorough tumor staging before radiotherapy
Biopsy
;
Brain
;
Disease-Free Survival
;
Humans
;
Medulloblastoma*
;
Neck
;
Neoplasm Metastasis
;
Neoplasm Staging
;
Radiotherapy*
;
Seoul
;
Spine
;
Survival Rate
;
Survivors
;
Tumor Burden
9.Patterns of Failure Following Multimodal Treatment for Medulloblastoma: Long-Term Follow-up Results at a Single Institution.
Dong Soo LEE ; Jaeho CHO ; Se Hoon KIM ; Dong Seok KIM ; Kyu Won SHIM ; Chuhl Joo LYU ; Jung Woo HAN ; Chang Ok SUH
Cancer Research and Treatment 2015;47(4):879-888
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.
Combined Modality Therapy*
;
Craniospinal Irradiation
;
Follow-Up Studies*
;
Humans
;
Infratentorial Neoplasms
;
Medulloblastoma*
;
Radiotherapy
;
Recurrence
;
Subarachnoid Space
;
Survival Rate
;
Survivors
10.Clinical Analysis of Posterior Fossa Medulloblastoma in Children.
Cheol Wan PARK ; Kwang Myung KIM ; Suck Jun OH ; Nam Kyu KIM ; Hwan Yung CHUNG ; Hahng LEE ; Seung Ro LEE ; Myung Za LEE
Journal of Korean Neurosurgical Society 1990;19(4):549-558
The author analyzed 15 children with medulloblastoma confirmed histopathologically at the Department of Neurosurgery of the Hanyang University Hospital from Jan. 1981 to Jan. 1989. The results were as followings : 1) The mean age of incidence was 9.3 years and male to female ratio was 2 : 1. 2) The most common symptoms were those of increased intracranial pressure noted in all cases(100.0%), cerebellar symptoms and signs in 7 cases(46.7%) and the brain stem symptoms and signs in 2 cases(13.3%). The symptom duration varied from 7 to 180 days with a mean of 60 days. 3) In the majority of patients(12 cases, 80.0%), tumor was located in the midline on the computed tomographic scanning of the brain and as less typical features of the medulloblastoma, calcification and cystic or necrotic zone within the tumor mass occurred in 5 cases(33.3%) and in 6 cases(40.0%) respectively, suggesting higher frequency than observed in other articles. 4) The tumors with calcification within tumor mass were larger in size and presented with longer symptom duration than those without calcification. And tumors with cystic or necrotic zone within tumor mass were larger in size and presented with shorter symptom duration than those without such lesions. 5) Among 8 cases managed with various degree of surgical resections and full doses of postoperative radiotherapy, spinal metastasis occurred in 1 case(12.5%) at 26 months after the operation. 6) In conclusion, aggressive therapeutic approach with combined modalities, utilizing radical resection of the tumor, scheduled postoperative radiotherapy and chemotherapy, seemed to exert beneficial influence on the outcome, with no evidence of disease in 4 out of 6 cases during the follow up period of 8 to 27 months.
Brain
;
Brain Stem
;
Child*
;
Drug Therapy
;
Female
;
Follow-Up Studies
;
Humans
;
Incidence
;
Intracranial Pressure
;
Male
;
Medulloblastoma*
;
Neoplasm Metastasis
;
Neurosurgery
;
Radiotherapy