Introduction Radiotherapy of the posterior fossa is routinely delivered using 3DCRT parallel-oppo... more Introduction Radiotherapy of the posterior fossa is routinely delivered using 3DCRT parallel-opposed lateral fields. However high incidence of sensorineural hearing loss, hypothalamic–pituitary dysfunction, thyroid and gonadal dysfunction during radiotherapy makes the need for treatment plan which provides adequate coverage of the target volume while sparing of the cochlea and other surrounding organs at risk (OARs) at same time inevitable. Aim of the work To compare the coverage of posterior fossa and the dose to surrounding OARs including non-posterior fossa brain, pituitary, cochlea, eyes, optic nerves, optic chiasm, cervical spinal cord, thyroid gland, pharynx, parotid glands and mandible using three different 3DCRT plans. Methods Ten patients underwent CT simulation for treatment planning of posterior fossa boost. The CT data were transferred to Precise Elekta treatment planning system where posterior fossa, non-posterior fossa brain, pituitary, cochlea, parotid glands, cervica...
NEURO-ONCOLOGY • JUNE 2018 to Jun 2017. Three treatment regimens were used: MSKCC, SIOP CNS GCT 9... more NEURO-ONCOLOGY • JUNE 2018 to Jun 2017. Three treatment regimens were used: MSKCC, SIOP CNS GCT 96 and SIOP CNS GCT II. RESULTS: Thirty patients were identified with a median follow-up of 4.04 years (range 0.17-19.10). The mean age was 10.23 years. Male: female ratio was 5:1. Visual impairment (50%), endocrinopathy (30%) and precocious puberty (20%) were the commonest presenting symptoms. Duration of symptoms prior to presentation ranged from 1 to 108 weeks. Pure germinomas (n=15) and non-germinomatous germ cell tumours (NGGCT) (n=15) were equally distributed. Tumour location was pineal in 15 (50.0%), suprasellar in 8 (26.7%), hypothalamic in 2 (6.7%) and other sites (basal ganglia, thalamus, frontal lobe) in 5 (16.7%) patients. Eight patients (26.7%) had metastatic disease at diagnosis. Four cases underwent surgical debulking, 14 were biopsied and 7 had complete resection. Fifteen patients received chemo-radiotherapy, 7 had chemotherapy only and 8 underwent radiotherapy only. Elevated levels of serum alpha-fetoprotein and beta-human chorionic gonadotropin normalised after 2 courses of chemotherapy in all NGGCT cases. The 5-year event-free survival (EFS) and overall survival (OS) were 61.3 ± 14.1% and 78.3 ± 11.1% for pure germinoma, respectively. For NGGCT, the 5-year EFS and OS were 36.0 ± 13.3% and 41.3 ± 13.7%. Eleven recurrences occurred within a median duration of 11 months following diagnosis and 8 of them died within 10 months. CONCLUSION: Compared to pure germinoma, NGGCTs have poor prognosis.
Introduction Radiotherapy of the posterior fossa is routinely delivered using 3DCRT parallel-oppo... more Introduction Radiotherapy of the posterior fossa is routinely delivered using 3DCRT parallel-opposed lateral fields. However high incidence of sensorineural hearing loss, hypothalamic–pituitary dysfunction, thyroid and gonadal dysfunction during radiotherapy makes the need for treatment plan which provides adequate coverage of the target volume while sparing of the cochlea and other surrounding organs at risk (OARs) at same time inevitable. Aim of the work To compare the coverage of posterior fossa and the dose to surrounding OARs including non-posterior fossa brain, pituitary, cochlea, eyes, optic nerves, optic chiasm, cervical spinal cord, thyroid gland, pharynx, parotid glands and mandible using three different 3DCRT plans. Methods Ten patients underwent CT simulation for treatment planning of posterior fossa boost. The CT data were transferred to Precise Elekta treatment planning system where posterior fossa, non-posterior fossa brain, pituitary, cochlea, parotid glands, cervica...
NEURO-ONCOLOGY • JUNE 2018 to Jun 2017. Three treatment regimens were used: MSKCC, SIOP CNS GCT 9... more NEURO-ONCOLOGY • JUNE 2018 to Jun 2017. Three treatment regimens were used: MSKCC, SIOP CNS GCT 96 and SIOP CNS GCT II. RESULTS: Thirty patients were identified with a median follow-up of 4.04 years (range 0.17-19.10). The mean age was 10.23 years. Male: female ratio was 5:1. Visual impairment (50%), endocrinopathy (30%) and precocious puberty (20%) were the commonest presenting symptoms. Duration of symptoms prior to presentation ranged from 1 to 108 weeks. Pure germinomas (n=15) and non-germinomatous germ cell tumours (NGGCT) (n=15) were equally distributed. Tumour location was pineal in 15 (50.0%), suprasellar in 8 (26.7%), hypothalamic in 2 (6.7%) and other sites (basal ganglia, thalamus, frontal lobe) in 5 (16.7%) patients. Eight patients (26.7%) had metastatic disease at diagnosis. Four cases underwent surgical debulking, 14 were biopsied and 7 had complete resection. Fifteen patients received chemo-radiotherapy, 7 had chemotherapy only and 8 underwent radiotherapy only. Elevated levels of serum alpha-fetoprotein and beta-human chorionic gonadotropin normalised after 2 courses of chemotherapy in all NGGCT cases. The 5-year event-free survival (EFS) and overall survival (OS) were 61.3 ± 14.1% and 78.3 ± 11.1% for pure germinoma, respectively. For NGGCT, the 5-year EFS and OS were 36.0 ± 13.3% and 41.3 ± 13.7%. Eleven recurrences occurred within a median duration of 11 months following diagnosis and 8 of them died within 10 months. CONCLUSION: Compared to pure germinoma, NGGCTs have poor prognosis.
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