Medulloblastoma
medulloblastoma, ependymoma, leptomeningeal disease
RECURRENCES, DISEASE PROGRESSION, EPENDYMOMA, DISEASE, REMISSION, MEDULLOBLASTOMA, EVENTS
All 20 patients received EBRT prior to cRIT at a median time of 0.6 years (range, 0.1–4.9). Most patients (12, 60%) received EBRT as part of bridging therapy, nearly all (11, 92%) of which were re-irradiation and three were with protons (2 CSI, 1 focal; Table Swimmer’s plot demonstrating timing of treatments received and progression events. An arrowhead indicates that the patient was alive at the time of last follow-up. Those without an arrowhead indicate that the patient died at that time. *One patient was lost to follow-up and died of unknown causes. Four patients remain in remission: at cRIT initiation, three had NED and one had multifocal leptomeningeal disease in the spine. Sixteen patients ultimately had disease progression at a median time of 0.8 years (range, 0.2–4.0) after most recent relapse and 0.2 years (range, 0.1–3.4) after cRIT initiation. Half of those who progressed had NED at cRIT initiation: four progressed focally intracranially, two progressed multifocally intracranially, and one had LMD in the spine per outside report (Supplemental Fig. 2). The other half who progressed had MD at cRIT initiation, and these progression patterns were nearly all multifocal and/or diffuse with LMD, with the exception of one patient with isolated cytologic disease at baseline who ultimately developed focal intracranial LMD.Median PFS following cRIT for the medulloblastoma cohort was 0.4 years from cRIT initiation (95% CI 0.1–1.7; Fig. Survival outcomes among patients with medulloblastoma (top) and ependymoma (bottom) calculated from the time of pre-cRIT relapse. Survival outcomes among patients with medulloblastoma based on disease status at cRIT initiation. Among medulloblastoma patients, three underwent additional focal EBRT following cRIT for future recurrences. One patient received partial brain EBRT (2000 cGy), one patient received focal EBRT to the spine (2000 cGy), and one patient received three additional focal EBRT courses to the brain (maximum dose 3000 cGy). No patients received CSI post-cRIT.