2183 Fractionated radiotherapy in the treatment of neuroblastoma

I. J. Radiation

366

Oncology

0 Biology

0 Physics

Volume

36, Number

1, Supplement,

OF THE THECAL

SAC USING

MAGNETIC

RESONANCE

1996

2181 DETERMINATION ON CRANIOSPINAL

&role

OF THE INFERIOR IRRADIATION

B. Scharf, MD*,

*L.oyola-Hines

BORDER

Kenneth Goldberg,

Dept. of Radiotherapy

M.D.+

and +Division

IMAGING:

IMPLICATIONS

and Arnold C. Pauline, M.D.* of Neuroradiology,

Loyola University

Chicago, Maywood,

IL 60153

Purpose: Craniospinal irradiation (CSI) is employed in medulloblastoma and other immc&al malignancies that can seed the neuroaxis. betakentoadeqa@ycovertheendrecraniospinalaxis,inchrdingthedistalthecalsac. Theinfaorbordaofthecraniospinalfield~traditionallybeen placed at the bottom of the S2 vertebra. The purpose of this study is to review the level of thecal sac termination in children undergoing MagneiicRwonanceImaging(MRI).

Care muat CSI using

Methods and Materi& From lU87 to 10/95,22 chill were treated with CSI at one institution. All underwent pre-treatment MRI of the spine withGadoliniumaspsrtoftheireval~on ‘fhemedianagewas9yeam(range,31monthstol8years),andthaewere14malesand8fnnales. The diagnosiswasmedulloblastomainl4pati~pumkive neuroectodermaltumoroftheeenbnunin3,~o~in2,~~~in1,leptomeningeal gliomatosis in 1 and glioblastoma multiforme in 1. All spinal MRIs were reviewed by both neummdiologist and radiation oncologist to scwately detesminethelevelof~sac~~wl6chwasobtainedbydrawingahorizontalline~mthe~walimitofthespiaalthecatothecomsponding adjacent vertebral body. Resulg: Thethecalssc~onvariedfrommidS1tolowerS3. in5,midS2in3,lowerS2in3,S2-3jonctionin2,uppuS3inlsndlowerS3in1. junction. Eightpatierdshadspinal~~~rudthirthecalsac~~waedabovetheS2-3j~on the level of termination and age, gender or histology.

ItwaslocatedatmidS1in1patient,lowerS1in3,Sl-2junctionin3,upperS2 Only~2patients (9??)hadthecalsactermi~tionsbelowtheS2-3 The-rewasnocorrelationbetween

Condwions:

The majority of patients (91%) will have nxmbution of the thecaI sac above S3, and &a&ore placement of the inferior border of the spinal field at the S2-3 junction with a 1 cm caudal margin will be adequate coverage for most cases. MRI of the spine is still of paramount importance in determk@ spinal axis seeding. It may not be necessary in the placement of the caudal border of the craniospinal field in all patientq however, it may still have a role in young females whose ovarian tbnction may be compromised.

2182 CANCELLED

2183 FRACTIONATED Logan,

Drayton;

Department Indiana. Purpose:

RADIOTHERAPY Montebello,

of Radiation

To evaluate

IN TI-IE TREATMENT

Joseph F.; Timmerman,

Oncology

and ‘Department

the benefit of radiation

therapy

OF NEUROBLASTOMA

Robert D.; ‘Breitfeld, of Pediatric

Oncology,

for metastatic

Philip, and lKreissman, Indiana University

neuroblastoma

Susan

Medical

Center, Indianapolis,

patients.

Methods and Materials: From September 1970 to March 1995,90 patients with neuroblastoma were treated with fractionated radiotherapy. We looked at 42 patients with me&static disease and 170 sites that were treated for the following indications: pain, mass effect, mass/cosmesis, adjuvant, and consolidation. Data collected includes age at diagnosis, sex, site of radiation, dose, fractionation, purpose of treatment, response, duration of local control, status at follow-up, and date of death. Results:

Doses ranged from 100 cGy to 5000 cGy with a median dose of 2020 cGy. Median survival for this group of patienta with a maximum survival of 175.8 months and a minimum survival of two months. Patients whose sites were treated from 1970 - 1981 had a median survival of 22 months and a median dose of 2000 cGy compared to a survival of 26 months and a median dose of 1140 cGy for patients treated from 1981 - 1995. In patients ireated for gross disease, 53% had a complete response to treatment and 46% had a partial response. There was a 16% recurrence rate in sites treated. Median time to failure was five months, although this ranged from a minimum of one month to a maximum of 119 months. Median dose of the sites of failure was 2000 cGy. Thirty-three percent of sites were treated within two months of patients’ death.

was 23.7 months

Conclusion: Fractionated other modern treatments, metastatic sites.

radiotherapy is an dfectivc teabnent modality for palliation of metastatic neuroblastoma. Along with including chemotherapy, it appears a total dose of around 1200 cGy is sufficient for palliation of most