Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation

Christopher A. Devine; Kevin X. Liu; Myrsini Ioakeim-Ioannidou; Matthew Susko; Tina Y. Poussaint; Thierry A.G.M. Huisman; Mariam Aboian; Douglas Brown; Cierra Zaslowe-Dude; Avani D. Rao; Lawrence T. Orlina; Bhupendra Rawal; Sabine Mueller; Karen J. Marcus; Stephanie A. Terezakis; Steve E. Braunstein; Daphne A. Haas-Kogan

doi:10.1016/j.ijrobp.2019.08.039

Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation

Christopher A. Devine
, Kevin X. Liu
, Myrsini Ioakeim-Ioannidou
, Matthew Susko
, Tina Y. Poussaint
, Thierry A.G.M. Huisman
, Mariam Aboian
, Douglas Brown
, Cierra Zaslowe-Dude
, Avani D. Rao
, Lawrence T. Orlina
, Bhupendra Rawal
, Sabine Mueller
, Karen J. Marcus
, Stephanie A. Terezakis
, Steve E. Braunstein
, Daphne A. Haas-Kogan

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

PURPOSE: Brainstem necrosis is a rare, but dreaded complication of radiation therapy; however, data on the incidence of brainstem injury for tumors involving the posterior fossa in photon-treated patient cohorts are still needed.

METHODS AND MATERIALS: Clinical characteristics and dosimetric parameters were recorded for 107 pediatric patients who received photon radiation for posterior fossa tumors without brainstem involvement from 2000 to 2016. Patients were excluded if they received a prescription dose <50.4 Gy, a brainstem maximum dose <50.4 Gy, or had fewer than 2 magnetic resonance imaging scans within 18 months after radiation. Post-radiation therapy magnetic resonance imaging findings were recorded, and brainstem toxicity was graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.

RESULTS: The most common histologies were medulloblastoma (61.7%) and ependymoma (15.9%), and median age at diagnosis was 8.3 years (range, 0.8-20.7). Sixty-seven patients (62.6%) received craniospinal irradiation (median, 23.4 Gy; range, 18.0-39.6) as a component of their radiation therapy, and 39.3% and 40.2% of patients received an additional involved field or whole posterior fossa boost, respectively. Median prescribed dose was 55.8 Gy (range, 50.4-60.0). Median clinical and imaging follow-up were 4.7 years (range, 0.1-17.5) and 4.2 years (range, 0.1-17.3), respectively. No grade ≥2 toxicities were observed. The incidence of grade 1 brainstem necrosis was 1.9% (2 of 107). These patients were by definition asymptomatic and experienced resolution of imaging abnormality after 5.3 months and 2.1 years, respectively.

CONCLUSIONS: Risk of brainstem necrosis was minimal in this multi-institutional study of pediatric patients treated with photon radiation therapy for tumors involving the posterior fossa with no cases of symptomatic brainstem injury, suggesting that brainstem injury risk is minimal in patients treated with photon therapy.

Original language	English (US)
Pages (from-to)	1034-1042
Number of pages	9
Journal	International Journal of Radiation Oncology Biology Physics
Volume	105
Issue number	5
DOIs	https://doi.org/10.1016/j.ijrobp.2019.08.039
State	Published - Dec 1 2019

Bibliographical note

Funding Information:
Disclosures: A.D.R. receives a research grant from Augmenix. S.A.T. receives research grants from Elekta and ASELL. D.A.H-K. sits on the Clinical Advisory Board of Cellworks and receives research grants from Novartis. K.J.M receives royalties from Uptodate, is a member of the PDQ Editorial Board and is the Associate Editor of Pediatric Blood and Cancer.

Publisher Copyright:
© 2019

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SDG 3 Good Health and Well-being

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10.1016/j.ijrobp.2019.08.039

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Devine, C. A., Liu, K. X., Ioakeim-Ioannidou, M., Susko, M., Poussaint, T. Y., Huisman, T. A. G. M., Aboian, M., Brown, D., Zaslowe-Dude, C., Rao, A. D., Orlina, L. T., Rawal, B., Mueller, S., Marcus, K. J., Terezakis, S. A., Braunstein, S. E., & Haas-Kogan, D. A. (2019). Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation. International Journal of Radiation Oncology Biology Physics, 105(5), 1034-1042. https://doi.org/10.1016/j.ijrobp.2019.08.039

Devine, CA, Liu, KX, Ioakeim-Ioannidou, M, Susko, M, Poussaint, TY, Huisman, TAGM, Aboian, M, Brown, D, Zaslowe-Dude, C, Rao, AD, Orlina, LT, Rawal, B, Mueller, S, Marcus, KJ, Terezakis, SA, Braunstein, SE & Haas-Kogan, DA 2019, 'Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation', International Journal of Radiation Oncology Biology Physics, vol. 105, no. 5, pp. 1034-1042. https://doi.org/10.1016/j.ijrobp.2019.08.039

@article{ebba6dfe492747bb88928c458c101111,

title = "Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation",

abstract = "PURPOSE: Brainstem necrosis is a rare, but dreaded complication of radiation therapy; however, data on the incidence of brainstem injury for tumors involving the posterior fossa in photon-treated patient cohorts are still needed.METHODS AND MATERIALS: Clinical characteristics and dosimetric parameters were recorded for 107 pediatric patients who received photon radiation for posterior fossa tumors without brainstem involvement from 2000 to 2016. Patients were excluded if they received a prescription dose <50.4 Gy, a brainstem maximum dose <50.4 Gy, or had fewer than 2 magnetic resonance imaging scans within 18 months after radiation. Post-radiation therapy magnetic resonance imaging findings were recorded, and brainstem toxicity was graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.RESULTS: The most common histologies were medulloblastoma (61.7\%) and ependymoma (15.9\%), and median age at diagnosis was 8.3 years (range, 0.8-20.7). Sixty-seven patients (62.6\%) received craniospinal irradiation (median, 23.4 Gy; range, 18.0-39.6) as a component of their radiation therapy, and 39.3\% and 40.2\% of patients received an additional involved field or whole posterior fossa boost, respectively. Median prescribed dose was 55.8 Gy (range, 50.4-60.0). Median clinical and imaging follow-up were 4.7 years (range, 0.1-17.5) and 4.2 years (range, 0.1-17.3), respectively. No grade ≥2 toxicities were observed. The incidence of grade 1 brainstem necrosis was 1.9\% (2 of 107). These patients were by definition asymptomatic and experienced resolution of imaging abnormality after 5.3 months and 2.1 years, respectively.CONCLUSIONS: Risk of brainstem necrosis was minimal in this multi-institutional study of pediatric patients treated with photon radiation therapy for tumors involving the posterior fossa with no cases of symptomatic brainstem injury, suggesting that brainstem injury risk is minimal in patients treated with photon therapy.",

author = "Devine, \{Christopher A.\} and Liu, \{Kevin X.\} and Myrsini Ioakeim-Ioannidou and Matthew Susko and Poussaint, \{Tina Y.\} and Huisman, \{Thierry A.G.M.\} and Mariam Aboian and Douglas Brown and Cierra Zaslowe-Dude and Rao, \{Avani D.\} and Orlina, \{Lawrence T.\} and Bhupendra Rawal and Sabine Mueller and Marcus, \{Karen J.\} and Terezakis, \{Stephanie A.\} and Braunstein, \{Steve E.\} and Haas-Kogan, \{Daphne A.\}",

note = "Funding Information: Disclosures: A.D.R. receives a research grant from Augmenix. S.A.T. receives research grants from Elekta and ASELL. D.A.H-K. sits on the Clinical Advisory Board of Cellworks and receives research grants from Novartis. K.J.M receives royalties from Uptodate, is a member of the PDQ Editorial Board and is the Associate Editor of Pediatric Blood and Cancer. Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = dec,

day = "1",

doi = "10.1016/j.ijrobp.2019.08.039",

language = "English (US)",

volume = "105",

pages = "1034--1042",

journal = "International Journal of Radiation Oncology Biology Physics",

issn = "0360-3016",

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TY - JOUR

T1 - Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation

AU - Devine, Christopher A.

AU - Liu, Kevin X.

AU - Ioakeim-Ioannidou, Myrsini

AU - Susko, Matthew

AU - Poussaint, Tina Y.

AU - Huisman, Thierry A.G.M.

AU - Aboian, Mariam

AU - Brown, Douglas

AU - Zaslowe-Dude, Cierra

AU - Rao, Avani D.

AU - Orlina, Lawrence T.

AU - Rawal, Bhupendra

AU - Mueller, Sabine

AU - Marcus, Karen J.

AU - Terezakis, Stephanie A.

AU - Braunstein, Steve E.

AU - Haas-Kogan, Daphne A.

N1 - Funding Information: Disclosures: A.D.R. receives a research grant from Augmenix. S.A.T. receives research grants from Elekta and ASELL. D.A.H-K. sits on the Clinical Advisory Board of Cellworks and receives research grants from Novartis. K.J.M receives royalties from Uptodate, is a member of the PDQ Editorial Board and is the Associate Editor of Pediatric Blood and Cancer. Publisher Copyright: © 2019

PY - 2019/12/1

Y1 - 2019/12/1

N2 - PURPOSE: Brainstem necrosis is a rare, but dreaded complication of radiation therapy; however, data on the incidence of brainstem injury for tumors involving the posterior fossa in photon-treated patient cohorts are still needed.METHODS AND MATERIALS: Clinical characteristics and dosimetric parameters were recorded for 107 pediatric patients who received photon radiation for posterior fossa tumors without brainstem involvement from 2000 to 2016. Patients were excluded if they received a prescription dose <50.4 Gy, a brainstem maximum dose <50.4 Gy, or had fewer than 2 magnetic resonance imaging scans within 18 months after radiation. Post-radiation therapy magnetic resonance imaging findings were recorded, and brainstem toxicity was graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.RESULTS: The most common histologies were medulloblastoma (61.7%) and ependymoma (15.9%), and median age at diagnosis was 8.3 years (range, 0.8-20.7). Sixty-seven patients (62.6%) received craniospinal irradiation (median, 23.4 Gy; range, 18.0-39.6) as a component of their radiation therapy, and 39.3% and 40.2% of patients received an additional involved field or whole posterior fossa boost, respectively. Median prescribed dose was 55.8 Gy (range, 50.4-60.0). Median clinical and imaging follow-up were 4.7 years (range, 0.1-17.5) and 4.2 years (range, 0.1-17.3), respectively. No grade ≥2 toxicities were observed. The incidence of grade 1 brainstem necrosis was 1.9% (2 of 107). These patients were by definition asymptomatic and experienced resolution of imaging abnormality after 5.3 months and 2.1 years, respectively.CONCLUSIONS: Risk of brainstem necrosis was minimal in this multi-institutional study of pediatric patients treated with photon radiation therapy for tumors involving the posterior fossa with no cases of symptomatic brainstem injury, suggesting that brainstem injury risk is minimal in patients treated with photon therapy.

AB - PURPOSE: Brainstem necrosis is a rare, but dreaded complication of radiation therapy; however, data on the incidence of brainstem injury for tumors involving the posterior fossa in photon-treated patient cohorts are still needed.METHODS AND MATERIALS: Clinical characteristics and dosimetric parameters were recorded for 107 pediatric patients who received photon radiation for posterior fossa tumors without brainstem involvement from 2000 to 2016. Patients were excluded if they received a prescription dose <50.4 Gy, a brainstem maximum dose <50.4 Gy, or had fewer than 2 magnetic resonance imaging scans within 18 months after radiation. Post-radiation therapy magnetic resonance imaging findings were recorded, and brainstem toxicity was graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.RESULTS: The most common histologies were medulloblastoma (61.7%) and ependymoma (15.9%), and median age at diagnosis was 8.3 years (range, 0.8-20.7). Sixty-seven patients (62.6%) received craniospinal irradiation (median, 23.4 Gy; range, 18.0-39.6) as a component of their radiation therapy, and 39.3% and 40.2% of patients received an additional involved field or whole posterior fossa boost, respectively. Median prescribed dose was 55.8 Gy (range, 50.4-60.0). Median clinical and imaging follow-up were 4.7 years (range, 0.1-17.5) and 4.2 years (range, 0.1-17.3), respectively. No grade ≥2 toxicities were observed. The incidence of grade 1 brainstem necrosis was 1.9% (2 of 107). These patients were by definition asymptomatic and experienced resolution of imaging abnormality after 5.3 months and 2.1 years, respectively.CONCLUSIONS: Risk of brainstem necrosis was minimal in this multi-institutional study of pediatric patients treated with photon radiation therapy for tumors involving the posterior fossa with no cases of symptomatic brainstem injury, suggesting that brainstem injury risk is minimal in patients treated with photon therapy.

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U2 - 10.1016/j.ijrobp.2019.08.039

DO - 10.1016/j.ijrobp.2019.08.039

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SN - 0360-3016

VL - 105

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EP - 1042

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

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ER -

Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation

Abstract

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