paediatrics Brussels 17

I. J. Radiation Oncology d Biology d Physics

92

Volume 71, Number 1, 2008

Table 2. Patient disease control intervals and outcomes according to reirradiation volume and initial pattern of failure.

Reirradiation volume

Initial pattern of failure

PFS, RT1 (months)

PFS, RT2 (months)

PFSRT1/PF SRT2

RT2 progression

Disease status

Overall survival (months)

Patient

1 2 3 4 5 6 7 8 9

SRS SRS SRS SRS SRS SRS

Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local

10 20 27 37 66

18.50

1.80 0.31 0.43 1.11 1.89 3.28 8.44 0.15 0.41 0.58 2.85 0.41 8.72 0.16 0.23 0.42 1.77 1.33 0.41 7.15 1.01 0.99 1.74 1.40 1.07 0.45 3.24 1.89 2.23 0.19 0.00 1.56 0.23 0.53 0.38 0.76 0.31

Yes

DOD DOD DOD DOC

65.5 57.5 65.1 79.0

6.23

No

11.90 40.53

Yes Yes

125.27

No

NED 194.6

Metastatic

6 9 9

8.27

Yes

DOD

24.7

Local Local Local Local Local Local Local Local Local Local Local Local Local

76.83

No No

NED 190.2

1.43 4.10 7.70

SD

13.5 48.6 26.3 60.7 46.2 35.7 33.1 34.5 69.1 31.5 24.2 35.0 71.2 51.8 39.7 37.1 75.1 29.8 35.5 77.6 70.0 49.3 59.3 78.4 92.9

10 13 14 15 16 16 19 21 23 59 73 10 11 17 18 19 22 22 22 23 25 26 26 27 28 35 43 62 3 7

Yes Yes

DOD DOD NED DOD NED NED NED NED

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

38.63

No

6.07

Yes

136.33

No No No No No No No No

NED 169.8

2.63 4.43 8.67

41.10 78.47 29.87 22.17

NED 169.2 NED 109.6

CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI

Metastatic Combined Combined Metastatic Metastatic Metastatic Combined Metastatic Metastatic Metastatic Metastatic Metastatic Combined Metastatic

SD

6.80 9.63

Yes Yes Yes

DOD DOD

19.03 24.30 18.97 69.73 40.70 49.50 8.53

PD

No No

NED NED DOD

Yes

No No No No No No

NED 103.2

SD

139.9

NED NED

4.43 2.53

SD

261.03

10.21

NED 303.9

40.67

Yes Yes

PD

Local Local Local

6.03

DOD

14.87 13.30 32.40 19.30

No No

SD

NED

Metastatic Metastatic

Yes

PD SD

No

Abbreviations: SRS = stereotactic radiosurgery; CSI = craniospinal irradiation; PFS = progression-free survival; RT1 = initial radiation ther- apy; RT2 = reirradiation; DOD = dead of disease; DOC = dead of other causes; NED = no evidence of disease; SD = stable disease.

11.9 months and died, 2 experienced progression with com- bined local and distant recurrence at 8.3 and 18.5 months and died, 1 died of radiation necrosis at 40 months, and 1 patient remains without evidence of disease 10 years after SRS, but required surgery and HBOT 8 years after SRS for necrosis. Notably, all 4 patients who experienced disease progression and died had neuroimaging or pathologic evidence of necro- sis. Despite the poor outcome, the progression-free survival of second radiation course/progression-free survival of first radiation course (PFS RT2 /PFS RT1 ) ratio was greater than unity for 4 of 6 patients and was 1.89 for the only survivor, whose initial recurrence was experienced 66 months after her initial treatment with GTR and 50 Gy. : FFRT Thirteen patients with local failure were treated by using FFRT to a median dose of 52.2 Gy (range, 50.4–54 Gy). Me- RT 2

dian combined total dose was 111.6 Gy (range, 98.4–120 Gy). Median time from initiation of RT 1 to RT 2 was 23 months (range, 10–82 months), and from RT 1 failure to RT 2 , 4 months (range, 1–66 months). Twelve of 13 patients underwent repeated resection at the time of RT 1 failure. The group was composed of 11 patients with an infratentorial pri- mary tumor location. Surgery was not performed in 1 of 2 pa- tients with a supratentorial primary tumor location. Two patients underwent multiple attempts at resection and chemo- therapy regimens before RT 2 , which facilitated the two lon- gest delays from RT 1 failure to RT 2 of 23.4 and 66 months. Three patients in this group experienced progression with metastatic failure at 4, 6, and 7 months and subsequently died at 10, 17, and 20 months after RT 2 despite additional therapy. Widespread metastatic disease, including metastatic disease in the region of the primary site, made it difficult to determine the durability of local control. The remaining 10