Treatment/Prognosis Flashcards
What is the general Tx paradigm for CP tumors?
CP tumor Tx paradigm: max safe resection (after embolization/chemo, if necessary) +/− chemo (younger pts) and/or RT (if age >3 yrs)
What are the indications for RT in pts with CP tumors?
Age >3 yrs and any of the following: carcinoma histology, +CSF/spine Dz (CSI), or recurrent tumors
What is the role of RT in CPPs after STR?
No RT is necessary upfront, as only 50% of STR pts require reoperation, surgical salvage is good, and reoperation may not be needed until yrs later. Consider RT if there is an STR after recurrence. (Mayo data: Krishnan S et al., J Neurooncol 2004)
What is the recommended EB dose for CPPs?
Conventional RT: >50 Gy to localized field
Stereotactic RT: 12 Gy to 50% IDL (Pittsburgh data: Kim IY et al., J Neurosurg 2008)
What is the strongest indication for CSI?
Positive neuroaxis staging. If pt >3 yo, CSI can be given to 35 Gy f/b boost to primary site and/or mets up to 54 Gy.
What makes the resection of CPCs especially challenging?
CPCs are very friable and extremely vascular.
What can be attempted preoperatively to make resection easier?
Embolization (reduces intraop bleeding risk) or neoadj chemo
What agents may be used neoadjuvantly (after Bx and before 2nd-look Sg) for CPCs?
Ifosfamide, carboplatin, and etoposide (Wrede B et al., Anticancer Res 2005)
What data support the use of adj RT in CPCs?
Wrede B meta-analysis (Wrede B et al., J Neurooncol 2007): 5-yr OS 47% with RT and 25% w/o RT
Wolff JE et al., Br J Cancer 2002: for STR CPCs, 2-yr OS was 50% with RT and 0% w/o RT
What do the data show with regard to RT after GTR for CPC?
Study by Wolff JE et al., Lancet 1999 showed improved survival (5-yr OS was 68% with RT vs. 16% without) but only for older pts.
What meta-analysis supports the use of adj chemo for CPC?
Wrede meta-analysis (Wrede B et al., J Neurooncol 2007) of 857 pts; confirmed improved median OS rates (2.75 vs. 0.58 yrs) with adj chemo for subtotally resected CPCs.
What adj chemo arms were used in the CPT-SIOP-2000 study?
2 cycles of etoposide and vincristine with either carboplatin or cyclophosphamide. (Werde B et al., J Neurooncol 2009)
What study supports delaying RT in very young children with CPCs?
“Baby” Pediatric Oncology Group study: 8 CPC pts treated with Sg, chemo, and delayed RT without any adverse sequelae. (Duffner PK et al., Pediatr Neurosurg 1995)
What data support CSI over smaller RT fields in CPC?
Mazloom A et al. reviewed the literature and found 56 pts with CPC; 5-yr PFS with CSI was 44.2% vs. 15.3% with smaller fields. (IJROBP 2010)
What is the 5-yr survival rate for CPPs?
The 5-yr survival rate is 80%–100% following GTR and 68% following STR.
What is the 5-yr survival rate for CPCs?
The 5-yr OS is only 20%–30%.
