Children and Adolescents with Recurrent Tumors in the Central Nervous System Reirradiation

ObjectiveTo report the epidemiology and associated health factors of children and adolescents who were subject to several rounds ofirradiation at the National Institute of Oncology and Radiobiology in Havana, CubaIntroductionIrradiation is often an integral part of the treatment for central nervous system tumors. However, it is particularly challengingto use for the treatment of pediatric and adolescents, as it has been predicted to have drastic effects on the developing brain.Recurrence is frequent and treatment is limited with a few management options. These patients often underwent several paralleltreatments including surgery and chemotherapy.Material and MethodsA retrospective, observational study was conducted for 17 children and adolescents aged 3 to 18-years, who had central nervoussystem tumor recurrences and were reirradiated with a linear accelerator, three dimensional (3D) planning with a dose range of36-56 Gy. Survival functions were estimated by Kaplan-Meier method.ResultsThe study included eight medulloblastomas, (47.1%); two germinomas, (11.8%); three astrocytomas grade III, (17.6%); twobrainstem tumors, (11.8%); one ependymoma, (5.9%) and one oligodendroglioma, (5.9%). All the patients responded to thetreatment, with survival rates of 62.5% and 25 % at 1 and 2-years, respectively. The median survival time after reirradiationwas 1.13-years. The median interval between radiation courses was 4.7-years. Median age at the first course of radiotherapy was9-years, and at the second irradiation 14-years. Median total dose for the 2 irradiation courses were 100 Gy. Five patients arestill alive with a survival time range of 7.5 and 0.9-years. The cognitive function in surviving patients was preserved, especiallyfor over 12-years of age. Three had a Karnofsky-Lansky (K-L) scale of 100%, and two patients had a K-L of 90% and 70%,respectively.ConclusionsReirradiation is an option to be considered in patients with relapsed tumors in order to extend survival time, with a good cognitive functions.