Proton radiation therapy for pediatric medulloblastoma and supratentorial primitive neuroectodermal tumors: outcomes for very young children treated with upfront chemotherapy

Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):120-6. doi: 10.1016/j.ijrobp.2013.05.017. Epub 2013 Jun 21.


Purpose: To report the early outcomes for very young children with medulloblastoma or supratentorial primitive neuroectodermal tumor (SPNET) treated with upfront chemotherapy followed by 3-dimensional proton radiation therapy (3D-CPT).

Methods and materials: All patients aged <60 months with medulloblastoma or SPNET treated with chemotherapy before 3D-CPT from 2002 to 2010 at our institution were included. All patients underwent maximal surgical resection, chemotherapy, and adjuvant 3D-CPT with either craniospinal irradiation followed by involved-field radiation therapy or involved-field radiation therapy alone.

Results: Fifteen patients (median age at diagnosis, 35 months) were treated with high-dose chemotherapy and 3D-CPT. Twelve of 15 patients had medulloblastoma; 3 of 15 patients had SPNET. Median time from surgery to initiation of radiation was 219 days. Median craniospinal irradiation dose was 21.6 Gy (relative biologic effectiveness); median boost dose was 54.0 Gy (relative biologic effectiveness). At a median of 39 months from completion of radiation, 1 of 15 was deceased after a local failure, 1 of 15 had died from a non-disease-related cause, and the remaining 13 of 15 patients were alive without evidence of disease recurrence. Ototoxicity and endocrinopathies were the most common long-term toxicities, with 2 of 15 children requiring hearing aids and 3 of 15 requiring exogenous hormones.

Conclusions: Proton radiation after chemotherapy resulted in good disease outcomes for a small cohort of very young patients with medulloblastoma and SPNET. Longer follow-up and larger numbers of patients are needed to assess long-term outcomes and late toxicity.

MeSH terms

  • Body Height
  • Cause of Death
  • Cerebellar Neoplasms / drug therapy
  • Cerebellar Neoplasms / mortality
  • Cerebellar Neoplasms / radiotherapy*
  • Chemotherapy, Adjuvant
  • Child, Preschool
  • Cranial Irradiation / adverse effects
  • Cranial Irradiation / methods
  • Endocrine System Diseases / etiology
  • Female
  • Hearing Loss, Sensorineural / etiology
  • Humans
  • Infant
  • Male
  • Medulloblastoma / drug therapy
  • Medulloblastoma / mortality
  • Medulloblastoma / radiotherapy*
  • Neuroectodermal Tumors, Primitive / drug therapy
  • Neuroectodermal Tumors, Primitive / mortality
  • Neuroectodermal Tumors, Primitive / radiotherapy*
  • Proton Therapy / adverse effects
  • Proton Therapy / methods*
  • Radiotherapy Dosage
  • Supratentorial Neoplasms / drug therapy
  • Supratentorial Neoplasms / mortality
  • Supratentorial Neoplasms / radiotherapy*
  • Treatment Outcome