Journal article
Imaging Changes in Pediatric Intracranial Ependymoma Patients Treated With Proton Beam Radiation Therapy Compared to Intensity Modulated Radiation Therapy
International journal of radiation oncology, biology, physics, Vol.93(1), pp.54-63
09/01/2015
DOI: 10.1016/j.ijrobp.2015.05.018
PMID: 26279024
Abstract
The clinical significance of magnetic resonance imaging (MRI) changes after radiation therapy (RT) in children with ependymoma is not well defined. We compared imaging changes following proton beam radiation therapy (PBRT) to those after photon-based intensity modulated RT (IMRT).
Seventy-two patients with nonmetastatic intracranial ependymoma who received postoperative RT (37 PBRT, 35 IMRT) were analyzed retrospectively. MRI images were reviewed by 2 neuroradiologists.
Sixteen PBRT patients (43%) developed postradiation MRI changes at 3.8 months (median) with resolution by 6.1 months. Six IMRT patients (17%) developed changes at 5.3 months (median) with 8.3 months to resolution. Mean age at radiation was 4.4 and 6.9 years for PBRT and IMRT, respectively (P = .06). Age at diagnosis (>3 years) and time of radiation (≥3 years) was associated with fewer imaging changes on univariate analysis (odds ratio [OR]: 0.35, P = .048; OR: 0.36, P = .05). PBRT (compared to IMRT) was associated with more frequent imaging changes, both on univariate (OR: 3.68, P = .019) and multivariate (OR: 3.89, P = .024) analyses. Seven (3 IMRT, 4 PBRT) of 22 patients with changes had symptoms requiring intervention. Most patients were treated with steroids; some PBRT patients also received bevacizumab and hyperbaric oxygen therapy. None of the IMRT patients had lasting deficits, but 2 patients died from recurrent disease. Three PBRT patients had persistent neurological deficits, and 1 child died secondarily to complications from radiation necrosis.
Postradiation MRI changes are more common with PBRT and in patients less than 3 years of age at diagnosis and treatment. It is difficult to predict causes for development of imaging changes that progress to clinical significance. These changes are usually self-limiting, but some require medical intervention, especially those involving the brainstem.
Details
- Title: Subtitle
- Imaging Changes in Pediatric Intracranial Ependymoma Patients Treated With Proton Beam Radiation Therapy Compared to Intensity Modulated Radiation Therapy
- Creators
- Jillian R Gunther - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasMariko Sato - Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer Center, Houston, TexasMurali Chintagumpala - Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer Center, Houston, TexasLeena Ketonen - Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TexasJeremy Y Jones - Department of Pediatric Radiology, Texas Children's Hospital, Houston, TexasPamela K Allen - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasArnold C Paulino - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer Center, Houston, TexasM Fatih Okcu - Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer Center, Houston, TexasJack M Su - Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Texas Children's Cancer Center, Houston, TexasJeffrey Weinberg - Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TexasNicholas S Boehling - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TexasSoumen Khatua - Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TexasAdekunle Adesina - Department of Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, TexasRobert Dauser - Department of Neurosurgery, Texas Children's Hospital, Houston, TexasWilliam E Whitehead - Department of Neurosurgery, Texas Children's Hospital, Houston, TexasAnita Mahajan - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: amahajan@mdanderson.org
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.93(1), pp.54-63
- DOI
- 10.1016/j.ijrobp.2015.05.018
- PMID
- 26279024
- NLM abbreviation
- Int J Radiat Oncol Biol Phys
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Publisher
- Elsevier Inc
- Grant note
- P30CA016672 / NCI NIH HHS
- Language
- English
- Date published
- 09/01/2015
- Academic Unit
- Stead Family Department of Pediatrics
- Record Identifier
- 9984093210002771
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