Late Effects of Craniospinal Irradiation Using Electron Spinal Fields for Pediatric Patients With Cancer

Authors

Brian De
Marcus A Florez
Ethan B Ludmir
Moshe H Maor
Susan L McGovern
Mary Frances McAleer
David R Grosshans
Eric L Chang
Anita Mahajan
Arnold C Paulino

Publication Date

1-1-2023

Journal

InternInterational Journal of Radiation Oncology, Biology, Physics

Abstract

Purpose: For children, craniospinal irradiation (CSI) with photons is associated with significant toxic effects. The use of electrons for spinal fields is hypothesized to spare anterior structures but the long-term effects remain uncertain. We studied late effects of CSI using electrons for spinal radiation therapy (RT).

Methods and materials: Records of 84 consecutive patients treated with CSI using electrons for the spine at a single institution between 1983 and 2014 were reviewed. Median age at RT was 5 (range, 1-14) years. The most common histologies were medulloblastoma/primitive neuroectodermal tumor (59%) and ependymoma (8%). The median prescribed dose to the entire spine was 30 Gy (range, 6-45). A subset of 48 (57%) patients aged 2 to 14 at RT with clinical follow-up for ≥5 years was analyzed for late effects. Height z scores adjusted for age before and after CSI were assessed using stature-for-age charts and compared with a t test.

Results: At median follow-up of 19 years (range, 0-38 years), the median survival was 22 years (95% confidence interval, 12-28 years) after RT, with 47 patients (56%) alive at last follow-up. On subset analysis for late effects, 19 (40%) patients developed hypothyroidism and 5 (10%) developed secondary malignancies. Other complications reported were esophageal stricture and periaortic hemorrhage in 1 and restrictive pulmonary disease in 1 patient. Median height z score before treatment was -0.4 (36th percentile; interquartile range, -1.0 to 0.0) and at last follow-up was -2.2 (first percentile; interquartile range, -3.1 to -1.6; P < .001). Of 44 patients with spinal curvature assessments, 15 (34%) had scoliosis with median Cobb angle 15° (range, 10°-35°) and 1 (2%) required surgery.

Conclusions: Frequent musculoskeletal toxic effects and predominantly decreased height were seen with long-term follow-up. Scoliosis and hypothyroidism were each seen in at least one-third of long-term survivors. However, clinically evident esophageal, pulmonary, and cardiac toxic effects were infrequent.

Keywords

Child, Humans, Infant, Child, Preschool, Adolescent, Craniospinal Irradiation, Electrons, Scoliosis, Medulloblastoma, Hypothyroidism, Disease Progression, Cerebellar Neoplasms

DOI

10.1016/j.ijrobp.2022.06.055

PMID

PMC11957918

PMCID

10.1016/j.ijrobp.2022.06.055

PubMedCentral® Posted Date

4-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes