title: Acute toxicity profile of craniospinal irradiation with intensity-modulated radiation therapy in children with medulloblastoma: A prospective analysis.
abstract: BACKGROUND
  To report on the acute toxicity in children with medulloblastoma undergoing intensity-modulated radiation therapy (IMRT) with daily intrafractionally modulated junctions.
  
  
  METHODS
  Newly diagnosed patients, aged 3-21, with standard-risk (SR) or high-risk (HR) medulloblastoma were eligible. A dose of 23.4 or 36.0 Gy in daily fractions of 1.8 Gy was prescribed to the craniospinal axis, followed by a boost to the primary tumor bed (54 or 55.8 Gy) and metastases (39.6-55.8 Gy), when indicated. Weekly, an intravenous bolus of vincristine was combined for patients with SR medulloblastoma and patients participating in the COG-ACNS-0332 study. Common toxicity criteria (CTC, version 2.0) focusing on skin, alopecia, voice changes, conjunctivitis, anorexia, dysphagia, gastro-intestinal symptoms, headache, fatigue and hematological changes were scored weekly during radiotherapy.
  
  
  RESULTS
  From 2010 to 2014, data from 15 consecutive patients (SR, n = 7; HR, n = 8) were collected. Within 72 h from onset of treatment, vomiting (66 %) and headache (46 %) occurred. During week 3 of treatment, a peak incidence in constipation (33 %) and abdominal pain/cramping (40 %) was observed, but only in the subgroup of patients (n = 9) receiving vincristine (constipation: 56 vs 0 %, P = .04; pain/cramping: 67 vs 0 %, P = .03). At week 6, 73 % of the patients developed faint erythema of the cranial skin with dry desquamation (40 %) or moist desquamation confined to the skin folds of the auricle (33 %). No reaction of the skin overlying the spinal target volume was observed.
  
  
  CONCLUSIONS
  Headache at onset and gastro-intestinal toxicity, especially in patients receiving weekly vincristine, were the major complaints of patients with medulloblastoma undergoing craniospinal irradiation with IMRT.
authors.affiliation: Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands. mauricecox94@gmail.com.
authors.forename: Maurice C
authors.initials: MC
authors.lastname: Cox
authors.affiliation: Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands. martijn.kusters@radboudumc.nl.
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Kusters
authors.affiliation: Department of Pediatric Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands. corrie.gidding@radboudumc.nl.
authors.forename: Corrie E
authors.initials: CE
authors.lastname: Gidding
authors.affiliation: Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands. jolanda.schieving@radboudumc.nl.
authors.forename: Jolanda H
authors.initials: JH
authors.lastname: Schieving
authors.affiliation: Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands. erik.vanlindert@radboudumc.nl.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: van Lindert
authors.affiliation: Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands. j.kaanders@radboudumc.nl.
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Kaanders
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Center for Pediatric Oncology, Utrecht, 3584, CX, The Netherlands. g.o.r.janssens@umcutrecht.nl.
authors.forename: Geert O
authors.initials: GO
authors.lastname: Janssens
mesh_terms: D000293:Adolescent; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects; D002528:Cerebellar Neoplasms / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D061888:Craniospinal Irradiation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000532:radiotherapy*; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D014750:Vincristine