1Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
2Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
3Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
4Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
5Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
6Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
7Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
8Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
9Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
10Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
11Department of Neurosurgery, National Cancer Center, Goyang, Korea
Copyright © 2021 by the Korean Cancer Association
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
All of data collection and analysis were performed after approval from the institutional review board (IRB No. 1904-010-1023) in accordance with the declaration of Helsinki. The written informed consent was waived in this retrospective study.
Author Contributions
Conceived and designed the analysis: Wang KC, Kim IH.
Collected the data: Lee JH, Eom KY, Phi JH, Park CK, Kim SK, Cho BK, Kim TM, Heo DS, Hong KT, Choi JY, Kang HJ, Shin HY, Choi SH, Lee ST, Park SH, Wang KC, Kim IH.
Contributed data or analysis tools: Lee JH, Kim IH.
Performed the analysis: Lee JH, Eom KY, Wang KC, Kim IH.
Wrote the paper: Lee JH, Wang KC, Kim IH.
Conflicts of Interest
Conflict of interest relevant to this article was not reported.
Factor | Value |
---|---|
Age (yr) | 15 (4–47) |
Sex | |
Male | 151 (79.9) |
Female | 38 (20.1) |
ECOG PS | |
0–1 | 156 (82.6) |
2 | 22 (11.6) |
3–4 | 11 (5.8) |
Tumor site | |
Solitary | |
Suprasellar | 41 (21.7) |
Pineal | 46 (24.3) |
BG/Thalamus | 29 (15.3) |
Othersa) | 3 (1.6) |
Bifocal | |
Suprasellar and pineal | 15 (7.9) |
Suprasellar and other | 5 (2.6) |
Pineal and other | 2 (1.1) |
Othersb) | 3 (1.6) |
Seeding (+) | |
CSF cytology (+) | 10 (5.3) |
Multiple lesions in MRI (+) | 22 (11.6) |
CSF cytology and MRI (+) | 13 (6.9) |
Tumor site | CTx | RT field | No. | Recurrence | ||
---|---|---|---|---|---|---|
Intracranial | Spinal | |||||
In-field | Out-field | |||||
Solitary/Bifocal | (−) | WB | 5 | 1 | - | 2 |
CSA | 36 | 2 | - | - | ||
(+) | IF only | 25 | 1a) | 4+1a) | - | |
WV | 54 | - | - | 1 | ||
WB | 3 | - | - | - | ||
CSA | 21 | - | - | - | ||
Multifocal/Seeding | (−) | CSA | 9 | - | - | - |
(+) | IF only | 3 | - | 2 | - | |
WV | 2 | - | - | - | ||
WB | 1 | - | - | - | ||
CSA | 30 | - | - | - |
Dose, median (range) | No.a) |
---|---|
Cranial field (WB/WV) | |
18 Gy (16–19) | 0/34 |
23 Gy (20–27) | 0/60 |
36 Gy (30–39) | 0/16 |
Spinal field to positive seeding | |
9 Gy (9) | 0/1 |
23 Gy (19–24) | 0/24 |
36 Gy (30–36) | 0/5 |
Involved field | |
Complete response | |
30 Gy (26–30) | 0/9 |
39 Gy (36–43) | 0/18 |
45 Gy (45–46) | 0/31 |
50 Gy (46–50) | 0/16 |
Not complete response | |
45 Gy (45–49) | 1/19 |
54 Gy (50–60) | 0/46 |
Factor | Hormone-replacement therapya) | Back to school (%)b) | NCF (%)c) | |||
---|---|---|---|---|---|---|
|
|
|
||||
Positive | p-valued) | Yes | p-valued) | Declined | p-valued) | |
Treatment | ||||||
|
||||||
RT | 10/19 (52.6) | 0.011 | 25/31 (80.7) | 0.022 | 8/29 (27.6) | 0.002 |
|
||||||
CRT | 22/93 (23.7) | 84/89 (94.4) | 9/121 (7.4) | |||
|
||||||
RT, total dose (Gy) | ||||||
|
||||||
≤ 50 | 13/57 (22.8) | 0.169 | 47/51 (92.0) | 0.670 | 4/69 (6.0) | 0.051 |
|
||||||
> 50 | 19/55 (34.6) | 62/69 (90.0) | 13/81 (16.0) | |||
|
||||||
WB RT | ||||||
|
||||||
WBRT | 22/52 (42.3) | 0.003 | 56/65 (86.2) | 0.053 | 12/79 (15.2) | 0.116 |
|
||||||
WVRT or IFRT only | 10/60 (16.7) | 53/55 (96.4) | 5/71 (7.0) | |||
|
||||||
WB/WV dose (Gy) | ||||||
|
||||||
≤ 30 | 12/85 (44.4) | 0.036 | 75/80 (94.0) | 0.120 | 8/111 (7.2) | 0.007 |
|
||||||
> 30 | 20/27 (23.5) | 34/40 (85.0) | 9/39 (23.1) |
Values are number/total (%). CRT, radiotherapy with upfront chemotherapy; IFRT, involved-field RT; NCF, severe neurocognitive dysfunction (limitation in daily activities, working or school performance); RT, radiotherapy; WB, whole brain; WV, whole ventricle.
a) Excluding initial hormone deficiency,
b) Patients in school-age,
c) Excluding patients inaccessible to neurocognitive questionnaire in the medical records,
d) Chi-square test.
Factor | Total | Event (%) | Incidence ratea) | Incidence rate ratio (95% CI) |
---|---|---|---|---|
Treatment | ||||
CRT | 135 | 3 (2.2) | 1.6 | 0.163 (0.027–0.715) |
RT | 44 | 7 (15.9) | 10.0 | |
WB RT | ||||
WBRT | 96 | 9 (9.4) | 6.4 | 7.208 (0.999–315.915) |
WVRT or IFRT only | 83 | 1 (1.2) | 0.9 | |
Total dose (Gy) | ||||
> 50 | 105 | 9 (8.6) | 6.3 | 7.001 (0.970–306.874) |
≤ 50 | 74 | 1 (1.3) | 0.1 | |
WB/WV RT dose (Gy) | ||||
> 30 | 58 | 8 (13.8) | 9.0 | 7.375 (1.472–71.294) |
≤ 30 | 121 | 2 (1.6) | 0.1 |
Patient characteristics
Factor | Value |
---|---|
Age (yr) | 15 (4–47) |
Sex | |
Male | 151 (79.9) |
Female | 38 (20.1) |
ECOG PS | |
0–1 | 156 (82.6) |
2 | 22 (11.6) |
3–4 | 11 (5.8) |
Tumor site | |
Solitary | |
Suprasellar | 41 (21.7) |
Pineal | 46 (24.3) |
BG/Thalamus | 29 (15.3) |
Others |
3 (1.6) |
Bifocal | |
Suprasellar and pineal | 15 (7.9) |
Suprasellar and other | 5 (2.6) |
Pineal and other | 2 (1.1) |
Others |
3 (1.6) |
Seeding (+) | |
CSF cytology (+) | 10 (5.3) |
Multiple lesions in MRI (+) | 22 (11.6) |
CSF cytology and MRI (+) | 13 (6.9) |
Values are presented as median (range) or number (%). BG, basal ganglia; CSF, craniospinal fluid; ECOG PS, Eastern Cooperative Oncology Group performance status; MRI, magnetic resonance imaging.
a)Including frontal lobe and temporal lobe,
b)Including temporal lobe, and midbrain.
Field of radiotherapy and pattern of recurrence
Tumor site | CTx | RT field | No. | Recurrence | ||
---|---|---|---|---|---|---|
Intracranial | Spinal | |||||
In-field | Out-field | |||||
Solitary/Bifocal | (−) | WB | 5 | 1 | - | 2 |
CSA | 36 | 2 | - | - | ||
(+) | IF only | 25 | 1 |
4+1 |
- | |
WV | 54 | - | - | 1 | ||
WB | 3 | - | - | - | ||
CSA | 21 | - | - | - | ||
Multifocal/Seeding | (−) | CSA | 9 | - | - | - |
(+) | IF only | 3 | - | 2 | - | |
WV | 2 | - | - | - | ||
WB | 1 | - | - | - | ||
CSA | 30 | - | - | - |
CSA, craniospinal axis followed by involved-field boost; CTx, chemotherapy; IF, involved-field; RT, radiotherapy; WB, whole brain followed by involved-field boost; WV, whole ventricle followed by involved-field boost.
a)Combined intracranial in-field and out-field recurrences in a case.
In-field recurrence according to radiation dose after upfront chemotherapy
Dose, median (range) | No. |
---|---|
Cranial field (WB/WV) | |
18 Gy (16–19) | 0/34 |
23 Gy (20–27) | 0/60 |
36 Gy (30–39) | 0/16 |
Spinal field to positive seeding | |
9 Gy (9) | 0/1 |
23 Gy (19–24) | 0/24 |
36 Gy (30–36) | 0/5 |
Involved field | |
Complete response | |
30 Gy (26–30) | 0/9 |
39 Gy (36–43) | 0/18 |
45 Gy (45–46) | 0/31 |
50 Gy (46–50) | 0/16 |
Not complete response | |
45 Gy (45–49) | 1/19 |
54 Gy (50–60) | 0/46 |
WB, whole brain followed by involved-field boost; WV, whole ventricle followed by involved-field boost.
a)Number of recurrences/total number of patients.
Late toxicities and treatment factors
Factor | Hormone-replacement therapy |
Back to school (%) |
NCF (%) | |||
---|---|---|---|---|---|---|
|
|
| ||||
Positive | p-value |
Yes | p-value |
Declined | p-value | |
Treatment | ||||||
| ||||||
RT | 10/19 (52.6) | 0.011 | 25/31 (80.7) | 0.022 | 8/29 (27.6) | 0.002 |
| ||||||
CRT | 22/93 (23.7) | 84/89 (94.4) | 9/121 (7.4) | |||
| ||||||
RT, total dose (Gy) | ||||||
| ||||||
≤ 50 | 13/57 (22.8) | 0.169 | 47/51 (92.0) | 0.670 | 4/69 (6.0) | 0.051 |
| ||||||
> 50 | 19/55 (34.6) | 62/69 (90.0) | 13/81 (16.0) | |||
| ||||||
WB RT | ||||||
| ||||||
WBRT | 22/52 (42.3) | 0.003 | 56/65 (86.2) | 0.053 | 12/79 (15.2) | 0.116 |
| ||||||
WVRT or IFRT only | 10/60 (16.7) | 53/55 (96.4) | 5/71 (7.0) | |||
| ||||||
WB/WV dose (Gy) | ||||||
| ||||||
≤ 30 | 12/85 (44.4) | 0.036 | 75/80 (94.0) | 0.120 | 8/111 (7.2) | 0.007 |
| ||||||
> 30 | 20/27 (23.5) | 34/40 (85.0) | 9/39 (23.1) |
Values are number/total (%). CRT, radiotherapy with upfront chemotherapy; IFRT, involved-field RT; NCF, severe neurocognitive dysfunction (limitation in daily activities, working or school performance); RT, radiotherapy; WB, whole brain; WV, whole ventricle.
a)Excluding initial hormone deficiency,
b)Patients in school-age,
c)Excluding patients inaccessible to neurocognitive questionnaire in the medical records,
d)Chi-square test.
Secondary malignancy and treatment factors
Factor | Total | Event (%) | Incidence rate |
Incidence rate ratio (95% CI) |
---|---|---|---|---|
Treatment | ||||
CRT | 135 | 3 (2.2) | 1.6 | 0.163 (0.027–0.715) |
RT | 44 | 7 (15.9) | 10.0 | |
WB RT | ||||
WBRT | 96 | 9 (9.4) | 6.4 | 7.208 (0.999–315.915) |
WVRT or IFRT only | 83 | 1 (1.2) | 0.9 | |
Total dose (Gy) | ||||
> 50 | 105 | 9 (8.6) | 6.3 | 7.001 (0.970–306.874) |
≤ 50 | 74 | 1 (1.3) | 0.1 | |
WB/WV RT dose (Gy) | ||||
> 30 | 58 | 8 (13.8) | 9.0 | 7.375 (1.472–71.294) |
≤ 30 | 121 | 2 (1.6) | 0.1 |
CI, confidence interval; CRT, radiotherapy with upfront chemotherapy; IFRT, involved-field RT; RT, radiotherapy; WB, whole brain; WV, whole ventricle.
a)Per 10,000 person-year.
Values are presented as median (range) or number (%). BG, basal ganglia; CSF, craniospinal fluid; ECOG PS, Eastern Cooperative Oncology Group performance status; MRI, magnetic resonance imaging. Including frontal lobe and temporal lobe, Including temporal lobe, and midbrain.
CSA, craniospinal axis followed by involved-field boost; CTx, chemotherapy; IF, involved-field; RT, radiotherapy; WB, whole brain followed by involved-field boost; WV, whole ventricle followed by involved-field boost. Combined intracranial in-field and out-field recurrences in a case.
WB, whole brain followed by involved-field boost; WV, whole ventricle followed by involved-field boost. Number of recurrences/total number of patients.
Values are number/total (%). CRT, radiotherapy with upfront chemotherapy; IFRT, involved-field RT; NCF, severe neurocognitive dysfunction (limitation in daily activities, working or school performance); RT, radiotherapy; WB, whole brain; WV, whole ventricle. Excluding initial hormone deficiency, Patients in school-age, Excluding patients inaccessible to neurocognitive questionnaire in the medical records, Chi-square test.
CI, confidence interval; CRT, radiotherapy with upfront chemotherapy; IFRT, involved-field RT; RT, radiotherapy; WB, whole brain; WV, whole ventricle. Per 10,000 person-year.