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XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA

A recent publication (PMID 33556478) demonstrated an increased risk of tumor recurrence in patients with newly-diagnosed pediatric medulloblastoma who have decreased lymphocyte counts early in their course of craniospinal radiation (CSI) (weeks 1 and 2). We set out to confirm this data in an indepen...

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Autores principales: Lindsay, Holly, Scheurer, Michael, Allam, Anthony, McGovern, Susan, Chintagumpala, Murali, Paulino, Arnold
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260070/
http://dx.doi.org/10.1093/neuonc/noad073.303
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author Lindsay, Holly
Scheurer, Michael
Allam, Anthony
McGovern, Susan
Chintagumpala, Murali
Paulino, Arnold
author_facet Lindsay, Holly
Scheurer, Michael
Allam, Anthony
McGovern, Susan
Chintagumpala, Murali
Paulino, Arnold
author_sort Lindsay, Holly
collection PubMed
description A recent publication (PMID 33556478) demonstrated an increased risk of tumor recurrence in patients with newly-diagnosed pediatric medulloblastoma who have decreased lymphocyte counts early in their course of craniospinal radiation (CSI) (weeks 1 and 2). We set out to confirm this data in an independent population of pediatric patients with newly-diagnosed medulloblastoma. We analyzed 54 patients treated from 1997-2013. All patients that received radiation in or after 2007 received protons. Per standard of care, patients with clinically high-risk disease were treated with 36-39.6 Gy CSI while patients with standard-risk disease received 23.4 Gy. Total dose to the primary site of disease ranged from 54-55.8 Gy. The mean patient age at diagnosis was 8 years. 16/54 (30%) patients developed a recurrence at an average of 30.2 months after diagnosis. Lymphocyte counts were analyzed both as a continuous variable and as CTCAE v5.0 grades (grades 0-2 lymphopenia (ALC >/=500) compared to grade 3 and 4 (ALC<500/mm3)) using Cox regression. As expected, patients with M+ disease had increased risk of tumor recurrence (p=0.001). There was no correlation between risk of tumor recurrence and early lymphopenia (weeks 0-3 radiation). However, in both weeks 4 and 5 of radiation, decreases in ALC closely correlated with an increased risk of tumor recurrence (week 4 p=0.038, week 5 p=0.042). Similarly, patients with grade 3/4 lymphopenia at weeks 4 and 5 of radiation had an increased risk of tumor recurrence (week 4 p=0.040, week 5 p=0.008) compared to those with grade 0-2 lymphopenia. In summary, both M+ disease and lymphopenia during weeks 4 and 5 of radiation correlated with an increased risk of tumor recurrence in pediatric medulloblastoma.
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spelling pubmed-102600702023-06-13 XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA Lindsay, Holly Scheurer, Michael Allam, Anthony McGovern, Susan Chintagumpala, Murali Paulino, Arnold Neuro Oncol Final Category: Radiation Oncology - XRT A recent publication (PMID 33556478) demonstrated an increased risk of tumor recurrence in patients with newly-diagnosed pediatric medulloblastoma who have decreased lymphocyte counts early in their course of craniospinal radiation (CSI) (weeks 1 and 2). We set out to confirm this data in an independent population of pediatric patients with newly-diagnosed medulloblastoma. We analyzed 54 patients treated from 1997-2013. All patients that received radiation in or after 2007 received protons. Per standard of care, patients with clinically high-risk disease were treated with 36-39.6 Gy CSI while patients with standard-risk disease received 23.4 Gy. Total dose to the primary site of disease ranged from 54-55.8 Gy. The mean patient age at diagnosis was 8 years. 16/54 (30%) patients developed a recurrence at an average of 30.2 months after diagnosis. Lymphocyte counts were analyzed both as a continuous variable and as CTCAE v5.0 grades (grades 0-2 lymphopenia (ALC >/=500) compared to grade 3 and 4 (ALC<500/mm3)) using Cox regression. As expected, patients with M+ disease had increased risk of tumor recurrence (p=0.001). There was no correlation between risk of tumor recurrence and early lymphopenia (weeks 0-3 radiation). However, in both weeks 4 and 5 of radiation, decreases in ALC closely correlated with an increased risk of tumor recurrence (week 4 p=0.038, week 5 p=0.042). Similarly, patients with grade 3/4 lymphopenia at weeks 4 and 5 of radiation had an increased risk of tumor recurrence (week 4 p=0.040, week 5 p=0.008) compared to those with grade 0-2 lymphopenia. In summary, both M+ disease and lymphopenia during weeks 4 and 5 of radiation correlated with an increased risk of tumor recurrence in pediatric medulloblastoma. Oxford University Press 2023-06-12 /pmc/articles/PMC10260070/ http://dx.doi.org/10.1093/neuonc/noad073.303 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Final Category: Radiation Oncology - XRT
Lindsay, Holly
Scheurer, Michael
Allam, Anthony
McGovern, Susan
Chintagumpala, Murali
Paulino, Arnold
XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA
title XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA
title_full XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA
title_fullStr XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA
title_full_unstemmed XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA
title_short XRT-07. LATE-ONSET LYMPHOPENIA DURING CRANIOSPINAL RADIATION IS ASSOCIATED WITH AN INCREASED RISK OF TUMOR RECURRENCE IN NEWLY-DIAGNOSED PEDIATRIC MEDULLOBLASTOMA
title_sort xrt-07. late-onset lymphopenia during craniospinal radiation is associated with an increased risk of tumor recurrence in newly-diagnosed pediatric medulloblastoma
topic Final Category: Radiation Oncology - XRT
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260070/
http://dx.doi.org/10.1093/neuonc/noad073.303
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