Safety and efficacy of concurrent carboplatin during full‐dose craniospinal irradiation for high‐risk/metastatic medulloblastoma in a resource‐limited setting. Issue 5 (3rd February 2021) - Gupta, Tejpal
Abstract: Purpose: To assess the safety and efficacy of concurrent carboplatin during craniospinal irradiation (CSI) in high‐risk/metastatic medulloblastoma defined as either residual tumor >1.5 cm 2 or leptomeningeal metastases. Methods: This single‐arm combined prospective (2005–2011) and retrospective (2011–2019) study was undertaken at a tertiary care cancer center in India. Following surgery, patients with newly diagnosed high‐risk/metastatic medulloblastoma received concurrent carboplatin (35 mg/m 2 ) for 15 days (day 1 to day 15) during CSI plus posterior fossa/tumor bed boost, followed by six cycles of standard adjuvant chemotherapy. Results: All 97 patients completed their planned course of radiotherapy without interruptions, except for two (2.1%) patients who had brief gaps due to treatment‐related toxicity. Grade 3–4 anemia, neutropenia, thrombocytopenia, and febrile neutropenia were seen in four (4.1%), 41 (42.2%) 21 (21.6%), and 18 (18.6%) patients, necessitating packed cell transfusion, granulocyte colony‐stimulating factor, and platelet support in five (5.1%), 41 (42.2%), and five (5.1%) patients, respectively, during the concurrent phase. Following myelorecovery, 92 (94.9%) patients completed the planned six cycles of standard adjuvant systemic chemotherapy. There were no treatment‐related deaths during the concurrent chemo‐radiotherapy phase, while three (3.1%) toxic deaths were ascribed to adjuvant chemotherapy‐related complications. At a median follow‐up of 82 months, the 5‐year Kaplan–Meier estimates of progression‐free survival and overall survival were 60.2% and 62.1%, respectively. On univariate analysis, leptomeningeal metastases (M0/M1 vs. M2/M3) and histological subtype (large cell/anaplastic vs. others) emerged as significant prognostic factors for survival. Conclusion: Addition of concurrent carboplatin to RT as radiosensitizing chemotherapy is a simple and effective way of treatment intensification in high‐risk/metastatic medulloblastoma.