Safety and efficacy of concurrent carboplatin during full‐dose craniospinal irradiation for high‐risk/metastatic medulloblastoma in a resource‐limited setting

• Published in: Pediatric blood & cancer 2021-05, Vol.68 (5), p.e28925-n/a
• Main Authors: Gupta, Tejpal, Sinha, Shwetabh, Chinnaswamy, Girish, Vora, Tushar, Prasad, Maya, Bhat, Vasudev, Goda, Jayant Sastri, Krishnatry, Rahul, Chatterjee, Abhishek, Epari, Sridhar, Sahay, Ayushi, Moiyadi, Aliasgar, Shetty, Prakash, Patil, Vijay, Khatua, Soumen, Jalali, Rakesh, Kurkure, Purna
• Format: Article
• Language: English
• Subjects: Carboplatin; Chemotherapy; concurrent; craniospinal irradiation; Hematology; high risk; leptomeningeal metastases; Leukocytes (granulocytic); Medical prognosis; Medulloblastoma; Meninges; Metastases; Metastasis; Neutropenia; Oncology; Patients; Pediatrics; Radiation therapy; Surgery; Thrombocytopenia; Toxicity
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.28925

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 cm2 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/m2) 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.