Safety and efficacy of concurrent carboplatin during full‐dose craniospinal irradiation for high‐risk/metastatic medulloblastoma in a resource‐limited setting
Tejpal Gupta, Shwetabh Sinha, Girish Chinnaswamy, Tushar Vora, Maya Prasad, Vasudev Bhat, Jayant Sastri Goda, Rahul Krishnatry, Abhishek Chatterjee, Sridhar Epari, Ayushi Sahay, Aliasgar Moiyadi, Prakash Shetty, Vijay Patil, Soumen Khatua, Rakesh Jalali, Purna Kurkure
Abstract
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.