Safety and Efficacy of Photon Re-Irradiation with Whole-Brain Radiotherapy or Craniospinal Irradiation for Recurrent Pediatric Central Nervous System Malignancies.
4 affiliations
- 1Department of Radiation Oncology, Mass General Brigham Cancer Institute, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA.
- 2Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, MA 02115, USA.
- 3Department of Neurosurgery, Boston Children's Hospital, Boston, MA 02115, USA.
- 4Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA 02115, USA.
Abstract
Background
Limited data exist regarding the safety and efficacy of photon re-irradiation with whole-brain radiotherapy (WBRT) or craniospinal irradiation (CSI) in children with recurrent or second primary CNS tumors.Materials and methods
In this retrospective single-institution study, 23 patients < 21 years who underwent photon re-irradiation with WBRT (n = 9) or CSI (n = 14) for CNS tumors between 2013 and 2026 were included. Clinical and treatment characteristics were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Toxicities were graded using CTCAE v5.0.Results
In our cohort, the median age at diagnosis was 8.5 years (range: 0.2-19.7 years), and medulloblastoma was the most common histology (30%). Median time to the first relapse after initial irradiation was 12.0 months (range: 0.9-92.5 months). Median re-irradiation dose to the whole brain or craniospinal axis was 24.0 Gy (range: 20.0-36.0 Gy). For 15 patients who received involved field boosts, median total dose was 30.6 Gy (range: 20.0-54.0 Gy). With median follow-up after re-RT of 12.2 months (range: 1.0-106.8), 12-month PFS and OS were 24.2% and 67.0%, respectively. Four patients who received curative-intent re-CSI remain alive with median follow-up of 20.4 months (range: 5.8-106.8). The crude rate of grade >2 CNS toxicity was 8.7%. Of 10 patients with new neurologic symptoms before re-irradiation, 7 (70%) had symptomatic improvement after treatment.Conclusions
Photon re-irradiation with WBRT or CSI was feasible and achieved disease control in a subset of patients and meaningful symptom palliation with acceptable acute toxicity. Careful attention to cumulative dose constraints is essential, and longer follow-up is needed to assess durability and late effects.
Related
- Re-irradiation with image-guided radiotherapy for recurrent cervical cancer: an analysis of outcomes and toxicity.
- Radiation-induced meningioma and high-grade glioma following craniospinal irradiation for medulloblastoma: a case report.
- Delayed elective nodal irradiation in head-and-neck cancer radiotherapy reduces acute lymphocyte damage, lymphopenia, and modulates immune signatures
- Radiotherapy and anatomically defined pelvic second primary malignancies in 10-year rectal cancer survivors
- Phase I/II Study of the PARP Inhibitor Olaparib and Irinotecan in Children and Young Adults with Recurrent/Refractory Malignancies: Arm D of the AcSé-ESMART Trial
BibTeX
@article{patel2026safety,
title = {{Safety and Efficacy of Photon Re-Irradiation with Whole-Brain Radiotherapy or Craniospinal Irradiation for Recurrent Pediatric Central Nervous System Malignancies.}},
author = {Palak P Patel and Hesham Elhalawani and Karen J Marcus and Lissa C Baird and Katie P Fehnel and Tom Rosenberg and Ralph Salloum and Ana Aguilar-Bonilla and Susan N Chi and Karen D Wright and Kee Kiat Yeo and Daphne A Haas-Kogan and Kevin X Liu},
journal = {Current oncology (Toronto, Ont.)},
year = {2026},
month = oct,
doi = {10.3390/curroncol33100617},
url = {https://europepmc.org/article/MED/42930184},
note = {CC BY},
}
RIS
TY - JOUR
TI - Safety and Efficacy of Photon Re-Irradiation with Whole-Brain Radiotherapy or Craniospinal Irradiation for Recurrent Pediatric Central Nervous System Malignancies.
AU - Palak P Patel
AU - Hesham Elhalawani
AU - Karen J Marcus
AU - Lissa C Baird
AU - Katie P Fehnel
AU - Tom Rosenberg
AU - Ralph Salloum
AU - Ana Aguilar-Bonilla
AU - Susan N Chi
AU - Karen D Wright
AU - Kee Kiat Yeo
AU - Daphne A Haas-Kogan
AU - Kevin X Liu
PY - 2026
DA - 2026/10/14
JO - Current oncology (Toronto, Ont.)
DO - 10.3390/curroncol33100617
UR - https://europepmc.org/article/MED/42930184
AB - Background Limited data exist regarding the safety and efficacy of photon re-irradiation with whole-brain radiotherapy (WBRT) or craniospinal irradiation (CSI) in children with recurrent or second primary CNS tumors.Materials and methods In this retrospective single-institution study, 23 patients < 21 years who underwent photon re-irradiation with WBRT (n = 9) or CSI (n = 14) for CNS tumors between 2013 and 2026 were included. Clinical and treatment characteristics were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Toxicities were graded using CTCAE v5.0.Results In our cohort, the median age at diagnosis was 8.5 years (range: 0.2-19.7 years), and medulloblastoma was the most common histology (30%). Median time to the first relapse after initial irradiation was 12.0 months (range: 0.9-92.5 months). Median re-irradiation dose to the whole brain or craniospinal axis was 24.0 Gy (range: 20.0-36.0 Gy). For 15 patients who received involved field boosts, median total dose was 30.6 Gy (range: 20.0-54.0 Gy). With median follow-up after re-RT of 12.2 months (range: 1.0-106.8), 12-month PFS and OS were 24.2% and 67.0%, respectively. Four patients who received curative-intent re-CSI remain alive with median follow-up of 20.4 months (range: 5.8-106.8). The crude rate of grade >2 CNS toxicity was 8.7%. Of 10 patients with new neurologic symptoms before re-irradiation, 7 (70%) had symptomatic improvement after treatment.Conclusions Photon re-irradiation with WBRT or CSI was feasible and achieved disease control in a subset of patients and meaningful symptom palliation with acceptable acute toxicity. Careful attention to cumulative dose constraints is essential, and longer follow-up is needed to assess durability and late effects.
SN - 1198-0052
SN - 1718-7729
ER -