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White matter lesions detected by magnetic resonance imaging after radiotherapy and high-dose chemotherapy in children with medulloblastoma or primitive neuroectodermal tumor.
J Clin Oncol. 2004 Nov 15; 22(22):4551-60.JC

Abstract

PURPOSE

White matter lesions (WMLs) have been described as a delayed effect of cranial irradiation in children with brain tumors, or a transient subacute effect characterized by an intralesional or perilesional reaction. We report the occurrence of subacute WMLs detected by magnetic resonance imaging (MRI) in children treated for medulloblastoma or primitive neuroectodermal tumor (PNET) and document the associated clinical, radiologic, and neurocognitive findings.

PATIENTS AND METHODS

Among 134 patients with medulloblastoma or supratentorial PNET treated prospectively with risk-adjusted craniospinal irradiation and conformal boost to the tumor bed, followed by four high-dose chemotherapy (HDC) cycles with stem-cell rescue, 22 developed WMLs on T1-weighted imaging with and without contrast and/or T2-weighted imaging on MRI. Patients had > or = 12 months of follow-up. Neurocognitive assessments included intelligence quotient (IQ) tests and tests of academic achievement.

RESULTS

Twenty-two patients developed WMLs at a median of 7.8 months after starting therapy (range, 1.9 to 13.0 months). Lesions were predominantly in the pons (n = 8) and cerebellum (n = 6). Sixteen patients (73%) had WML resolution at a median of 6.2 months (range, 1.68 to 23.5 months) after onset; two patients developed necrosis and atrophy. Three developed persistent neurologic deficits. Cumulative incidence of WMLs at 1 year was 15% +/- 3%. Patients with WMLs had a significant decline in estimated IQ (-2.5 per year; P = .03) and math (-4.5 per year; P = .003) scores.

CONCLUSION

WMLs in medulloblastoma or PNET patients treated with conformal radiotherapy and HDC are typically transient and asymptomatic, and may mimic early tumor recurrence. A minority of patients with WMLs develop permanent neurologic deficits and imaging changes. Overall, the presence of WMLs is associated with greater neurocognitive decline.

Authors+Show Affiliations

Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. maryam.fouladi@stjude.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15542806

Citation

Fouladi, Maryam, et al. "White Matter Lesions Detected By Magnetic Resonance Imaging After Radiotherapy and High-dose Chemotherapy in Children With Medulloblastoma or Primitive Neuroectodermal Tumor." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 22, no. 22, 2004, pp. 4551-60.
Fouladi M, Chintagumpala M, Laningham FH, et al. White matter lesions detected by magnetic resonance imaging after radiotherapy and high-dose chemotherapy in children with medulloblastoma or primitive neuroectodermal tumor. J Clin Oncol. 2004;22(22):4551-60.
Fouladi, M., Chintagumpala, M., Laningham, F. H., Ashley, D., Kellie, S. J., Langston, J. W., McCluggage, C. W., Woo, S., Kocak, M., Krull, K., Kun, L. E., Mulhern, R. K., & Gajjar, A. (2004). White matter lesions detected by magnetic resonance imaging after radiotherapy and high-dose chemotherapy in children with medulloblastoma or primitive neuroectodermal tumor. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 22(22), 4551-60.
Fouladi M, et al. White Matter Lesions Detected By Magnetic Resonance Imaging After Radiotherapy and High-dose Chemotherapy in Children With Medulloblastoma or Primitive Neuroectodermal Tumor. J Clin Oncol. 2004 Nov 15;22(22):4551-60. PubMed PMID: 15542806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - White matter lesions detected by magnetic resonance imaging after radiotherapy and high-dose chemotherapy in children with medulloblastoma or primitive neuroectodermal tumor. AU - Fouladi,Maryam, AU - Chintagumpala,Murali, AU - Laningham,Fred H, AU - Ashley,David, AU - Kellie,Stewart J, AU - Langston,James W, AU - McCluggage,Charles W, AU - Woo,Shaio, AU - Kocak,Mehmet, AU - Krull,Kevin, AU - Kun,Larry E, AU - Mulhern,Raymond K, AU - Gajjar,Amar, PY - 2004/11/16/pubmed PY - 2004/12/16/medline PY - 2004/11/16/entrez SP - 4551 EP - 60 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 22 IS - 22 N2 - PURPOSE: White matter lesions (WMLs) have been described as a delayed effect of cranial irradiation in children with brain tumors, or a transient subacute effect characterized by an intralesional or perilesional reaction. We report the occurrence of subacute WMLs detected by magnetic resonance imaging (MRI) in children treated for medulloblastoma or primitive neuroectodermal tumor (PNET) and document the associated clinical, radiologic, and neurocognitive findings. PATIENTS AND METHODS: Among 134 patients with medulloblastoma or supratentorial PNET treated prospectively with risk-adjusted craniospinal irradiation and conformal boost to the tumor bed, followed by four high-dose chemotherapy (HDC) cycles with stem-cell rescue, 22 developed WMLs on T1-weighted imaging with and without contrast and/or T2-weighted imaging on MRI. Patients had > or = 12 months of follow-up. Neurocognitive assessments included intelligence quotient (IQ) tests and tests of academic achievement. RESULTS: Twenty-two patients developed WMLs at a median of 7.8 months after starting therapy (range, 1.9 to 13.0 months). Lesions were predominantly in the pons (n = 8) and cerebellum (n = 6). Sixteen patients (73%) had WML resolution at a median of 6.2 months (range, 1.68 to 23.5 months) after onset; two patients developed necrosis and atrophy. Three developed persistent neurologic deficits. Cumulative incidence of WMLs at 1 year was 15% +/- 3%. Patients with WMLs had a significant decline in estimated IQ (-2.5 per year; P = .03) and math (-4.5 per year; P = .003) scores. CONCLUSION: WMLs in medulloblastoma or PNET patients treated with conformal radiotherapy and HDC are typically transient and asymptomatic, and may mimic early tumor recurrence. A minority of patients with WMLs develop permanent neurologic deficits and imaging changes. Overall, the presence of WMLs is associated with greater neurocognitive decline. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/15542806/White_matter_lesions_detected_by_magnetic_resonance_imaging_after_radiotherapy_and_high_dose_chemotherapy_in_children_with_medulloblastoma_or_primitive_neuroectodermal_tumor_ L2 - https://ascopubs.org/doi/10.1200/JCO.2004.03.058?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -