title: Radiotherapy after high-dose chemotherapy with autologous hematopoietic cell rescue: Quality assessment of Head Start III.
abstract: BACKGROUND
  The use of high-dose chemotherapy with autologous hematopoietic cell rescue (AuHCR) in Head Start III is a potentially curative approach for the management of young children with central nervous system neoplasms. We report the potential influence of quality and timing of radiation therapy on the survival of patients treated on the study.
  
  
  METHODS
  Between 2003 and 2009, 220 children with newly diagnosed central nervous system neoplasms were enrolled on the study. Radiation therapy was indicated following AuHCR for children between 6 and 10 years old or those younger than 6 years with residual tumor preconsolidation. Records were received for 42 patients and reviewed to determine adherence to protocol treatment volume and dose guidelines. Of these patients, seven were irradiated prior to consolidation, and additional four patients who initially avoided radiation therapy after AuHCR were subsequently treated at relapse.
  
  
  RESULTS
  Of the 31 patients who were fully evaluable, 2 refused radiation therapy until recurrence and 4 progressed between recovery from AuHCR and radiation therapy. Of the remaining 25 patients, 8 had violations in their indication, dose, or treatment volume. All violations occurred in patients under 6 years of age. Two patients could have avoided radiation therapy. There were 6 violations in the 23 patients who received radiation therapy for guideline indications.
  
  
  CONCLUSIONS
  All protocol violations occurred in patients under 6 years of age and were associated with decreased overall survival as was the time to start radiotherapy of greater than 11 weeks. When indicated, starting radiation therapy soon after neutrophil and platelet recovery may improve the outcome for these high-risk children.
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.|Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wong
authors.affiliation: University of Central Florida College of Medicine, Orlando, Florida.
authors.forename: Sean
authors.initials: S
authors.lastname: All
authors.affiliation: Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Waxer
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.|Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Olch
authors.affiliation: Texas Children's Hospital, Houston, Texas.|Baylor College of Medicine, Houston, Texas.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Venkatramani
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Girish
authors.initials: G
authors.lastname: Dhall
authors.affiliation: Division of Hematology/Oncology, University of California Los Angeles, Pediatrics, Los Angeles, California.
authors.forename: Tom Belle
authors.initials: TB
authors.lastname: Davidson
authors.affiliation: MD Anderson Cancer Center, Pediatrics Neuro-oncology Program, Houston, Texas.
authors.forename: Wafik
authors.initials: W
authors.lastname: Zaky
authors.affiliation: Department of Pediatrics, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Finlay
mesh_terms: D016543:Central Nervous System Neoplasms / Q000401:mortality* / Q000628:therapy*; D059248:Chemoradiotherapy; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006412:Hematopoietic Stem Cells; D006801:Humans; D007223:Infant; D008297:Male; D015996:Survival Rate
keywords: central nervous system tumors; neuro-oncology; outcomes research; pediatric hematology/oncology; radiation oncology; radiation therapy