Definitive treatment of leptomeningeal spinal metastases in children

Geoffrey L. Ray, Jeffrey C. Buchsbaum, Kevin P. Mcmullen, R. Victor Simoneaux, Matthew Hines, James G. Douglas, Peter A S Johnstone

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Uniquely in children, the existence of leptomeningeal spinal metastases does not confer a uniformly grave prognosis. Although the radiation tolerance of the spinal cord is of significant concern in these cases, the chemo- and radiosensitivity of these lesions argues for an aggressive approach where possible. Methods: The records of the Indiana University Health Proton Therapy Center were reviewed for patients undergoing proton beam therapy with curative intent for LSM between January 1, 2004 and July 7, 2012. Patients with microscopic disease only on LP were not included. Particulars of therapy, including dose, field sizes, toxicities, and outcomes were collated. Results: Twenty-two children received therapy as described, of median age 5 years (range 1.1-17.1). Patients had medulloblastoma (n=9), ATRT (n=4), ependymoma, and PNET (n=3 each). Five lesions (23%) were chemo-recurrent, though no patient had prior radiation to the spine. Median follow-up was 14 months (range 4-33) for all living patients. Fifteen (68%) children continued to have local control at last follow-up visit. Median dose was 37.8Gy (range 21.6-54Gy). Eight patients with chemo-recurrent disease or diffuse cord seeding did poorly, with local control and overall survival achieved in four. The 12-month overall survival was 68% with grade 1 skin erythema as the most frequent toxicity. Conclusions: We describe a cohort of LSM patients treated with RT with definitive intent, and the only available data from the proton environment. Durable response is possible for these children in over two-thirds of cases. Significant toxicity was infrequent using proton radiotherapy and these fractionation schemes. Pediatr Blood Cancer 2013;60:1839-1841.

Original languageEnglish
Pages (from-to)1839-1841
Number of pages3
JournalPediatric Blood and Cancer
Volume60
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Neoplasm Metastasis
Proton Therapy
Radiation Tolerance
Therapeutics
Protons
Primitive Neuroectodermal Tumors
Ependymoma
Medulloblastoma
Survival
Erythema
Spinal Cord
Spine
Radiotherapy
Radiation
Skin
Health
Neoplasms

Keywords

  • Leptomeningeal spinal metastases
  • Pediatric oncology
  • Protons
  • Radiation oncology

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Ray, G. L., Buchsbaum, J. C., Mcmullen, K. P., Simoneaux, R. V., Hines, M., Douglas, J. G., & Johnstone, P. A. S. (2013). Definitive treatment of leptomeningeal spinal metastases in children. Pediatric Blood and Cancer, 60(11), 1839-1841. https://doi.org/10.1002/pbc.24659

Definitive treatment of leptomeningeal spinal metastases in children. / Ray, Geoffrey L.; Buchsbaum, Jeffrey C.; Mcmullen, Kevin P.; Simoneaux, R. Victor; Hines, Matthew; Douglas, James G.; Johnstone, Peter A S.

In: Pediatric Blood and Cancer, Vol. 60, No. 11, 11.2013, p. 1839-1841.

Research output: Contribution to journalArticle

Ray, GL, Buchsbaum, JC, Mcmullen, KP, Simoneaux, RV, Hines, M, Douglas, JG & Johnstone, PAS 2013, 'Definitive treatment of leptomeningeal spinal metastases in children', Pediatric Blood and Cancer, vol. 60, no. 11, pp. 1839-1841. https://doi.org/10.1002/pbc.24659
Ray GL, Buchsbaum JC, Mcmullen KP, Simoneaux RV, Hines M, Douglas JG et al. Definitive treatment of leptomeningeal spinal metastases in children. Pediatric Blood and Cancer. 2013 Nov;60(11):1839-1841. https://doi.org/10.1002/pbc.24659
Ray, Geoffrey L. ; Buchsbaum, Jeffrey C. ; Mcmullen, Kevin P. ; Simoneaux, R. Victor ; Hines, Matthew ; Douglas, James G. ; Johnstone, Peter A S. / Definitive treatment of leptomeningeal spinal metastases in children. In: Pediatric Blood and Cancer. 2013 ; Vol. 60, No. 11. pp. 1839-1841.
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abstract = "Background: Uniquely in children, the existence of leptomeningeal spinal metastases does not confer a uniformly grave prognosis. Although the radiation tolerance of the spinal cord is of significant concern in these cases, the chemo- and radiosensitivity of these lesions argues for an aggressive approach where possible. Methods: The records of the Indiana University Health Proton Therapy Center were reviewed for patients undergoing proton beam therapy with curative intent for LSM between January 1, 2004 and July 7, 2012. Patients with microscopic disease only on LP were not included. Particulars of therapy, including dose, field sizes, toxicities, and outcomes were collated. Results: Twenty-two children received therapy as described, of median age 5 years (range 1.1-17.1). Patients had medulloblastoma (n=9), ATRT (n=4), ependymoma, and PNET (n=3 each). Five lesions (23{\%}) were chemo-recurrent, though no patient had prior radiation to the spine. Median follow-up was 14 months (range 4-33) for all living patients. Fifteen (68{\%}) children continued to have local control at last follow-up visit. Median dose was 37.8Gy (range 21.6-54Gy). Eight patients with chemo-recurrent disease or diffuse cord seeding did poorly, with local control and overall survival achieved in four. The 12-month overall survival was 68{\%} with grade 1 skin erythema as the most frequent toxicity. Conclusions: We describe a cohort of LSM patients treated with RT with definitive intent, and the only available data from the proton environment. Durable response is possible for these children in over two-thirds of cases. Significant toxicity was infrequent using proton radiotherapy and these fractionation schemes. Pediatr Blood Cancer 2013;60:1839-1841.",
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AB - Background: Uniquely in children, the existence of leptomeningeal spinal metastases does not confer a uniformly grave prognosis. Although the radiation tolerance of the spinal cord is of significant concern in these cases, the chemo- and radiosensitivity of these lesions argues for an aggressive approach where possible. Methods: The records of the Indiana University Health Proton Therapy Center were reviewed for patients undergoing proton beam therapy with curative intent for LSM between January 1, 2004 and July 7, 2012. Patients with microscopic disease only on LP were not included. Particulars of therapy, including dose, field sizes, toxicities, and outcomes were collated. Results: Twenty-two children received therapy as described, of median age 5 years (range 1.1-17.1). Patients had medulloblastoma (n=9), ATRT (n=4), ependymoma, and PNET (n=3 each). Five lesions (23%) were chemo-recurrent, though no patient had prior radiation to the spine. Median follow-up was 14 months (range 4-33) for all living patients. Fifteen (68%) children continued to have local control at last follow-up visit. Median dose was 37.8Gy (range 21.6-54Gy). Eight patients with chemo-recurrent disease or diffuse cord seeding did poorly, with local control and overall survival achieved in four. The 12-month overall survival was 68% with grade 1 skin erythema as the most frequent toxicity. Conclusions: We describe a cohort of LSM patients treated with RT with definitive intent, and the only available data from the proton environment. Durable response is possible for these children in over two-thirds of cases. Significant toxicity was infrequent using proton radiotherapy and these fractionation schemes. Pediatr Blood Cancer 2013;60:1839-1841.

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