Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma

Fatima Tensaouti (1, 2) , Anne Ducassou (2) , Leonor L. Chaltiel (2) , Stéphanie Bolle (3, 4) , Jean Louis Habrand (5, 6) , Claire Alapetite (7) , Bernard Coche-Dequeant (8) , Valerie Bernier (9) , Line Claude (10) , Christian Carrie (10) , Laetitia Padovani (11) , Xavier Muracciole (11) , Stephane Supiot (12) , Aymeri Huchet (13) , Julie Leseur (14) , Christine Kerr (15) , Grégorie Hangard (2) , Albert Lisbona (12) , Farid Goudjil (7) , Régis Ferrand (2) , Anne Laprie (1, 2, 16)

1 ToNIC - Toulouse Neuro Imaging Center
2 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
3 IGR - Institut Gustave Roussy
4 Département de cancérologie et radiothérapie
5 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
6 ABTE - Aliments Bioprocédés Toxicologie Environnements
7 Institut Curie [Paris]
8 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
9 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
10 Centre Léon Bérard [Lyon]
11 TIMONE - Hôpital de la Timone [CHU - APHM]
12 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
13 CHU Bordeaux [Bordeaux]
14 CRLCC - Centre Eugène Marquis
15 ICM - Institut du Cancer de Montpellier
16 UT3 - Université Toulouse III - Paul Sabatier

Background and purpose: Pediatric ependymoma carries a dismal prognosis, mainly owing to local relapse within RT fields. The current prospective European approach is to increase the radiation dose with a sequential hypofractionated stereotactic boost. In this study, we assessed the possibility of using a simultaneous integrated boost (SIB), comparing VMAT vs. IMPT dose delivery. Material and methods: The cohort included 101 patients. The dose to planning target volume (PTV59.4) was 59.4/1.8 Gy, and the dose to SIB volume (PTV67.6) was 67.6/2.05 Gy. Gross tumor volume (GTV) was defined as the tumor bed plus residual tumor, clinical target volume (CTV59.4) was GTV + 5 mm, and PTV59.4 was CTV59.4 + 3 mm. PTV67.6 was GTV+ 3 mm. After treatment plan optimization, quality indices and doses to target volume and organs at risk (OARs) were extracted and compared with the standard radiation doses that were actually delivered (median = 59.4 Gy [50.4 59.4]). Results: In most cases, the proton treatment resulted in higher quality indices (p < 0.001). Compared with the doses that were initially delivered, mean, and maximum doses to some OARs were no higher with SIB VMAT, and significantly lower with protons (p < 0.001). In the case of posterior fossa tumor, there was a lower dose to the brainstem with protons, in terms of V59 Gy, mean, and near-maximum (D2%) doses. Conclusion: Dose escalation with intensity-modulated proton or photon SIB is feasible in some patients. This approach could be considered for children with unresectable residue or post-operative FLAIR abnormalities, particularly if they have supratentorial tumors. It should not be considered for infratentorial tumors encasing the brainstem or extending to the medulla.

Keywords: ependymoma; boost; intracranial; photon therapy; proton therapy; treatment planning

Domains: Life Sciences [q-bio]; Cancer; Life Sciences [q-bio]; Neurons and Cognition [q-bio.NC]; Life Sciences [q-bio]; Human health and pathology; Pediatrics; Life Sciences [q-bio]; Bioengineering; Nuclear medicine

Fatima Tensaouti, Anne Ducassou, Leonor L. Chaltiel, Stéphanie Bolle, Jean Louis Habrand, et al.. Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma. Frontiers in Oncology, 2019, 9, pp.531. ⟨10.3389/fonc.2019.00531⟩. ⟨hal-02478956⟩