144PD - Cranio-Spinal irradiation – is acute hematological toxicity under-reported? A single institutional experience

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session CNS tumours
Topics Complications/Toxicities of Treatment
Central Nervous System Malignancies
Surgical Oncology
Presenter Pragyat Thakur
Citation Annals of Oncology (2016) 27 (suppl_9): ix42-ix45. 10.1093/annonc/mdw578
Authors P. Thakur1, N. Kumar2, R. Miriyala3, S. Ghoshal1
  • 1Radiotherapy, Post Graduate Institute of Medical Education and Research (PGIMER), 160012 - Chandigarh/IN
  • 2Radiotherapy And Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), 160012 - Chandigarh/IN
  • 3Radiotherapy And Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), 160011 - Chandigarh/IN



To analyze treatment interruptions due to acute hematological toxicity in patients of medulloblastoma receiving cranio-spinal irradiation (CSI).


Case records of 52 patients of medulloblastoma treated between 2011 and 2014 were retrospectively analyzed for hematological toxicity and treatment interruptions. In our department, blood counts are monitored twice a week during CSI and spinal fields are interrupted for patients with ≥ grade II hematological toxicity. Spinal irradiation is resumed after recovery to grade I level (TLC > 3000; platelet count > 75,000).


Median age was 11 years. All patients received adjuvant CSI of 36 Gy, followed by boost of 18 Gy to posterior fossa, at 1.8 Gy per fraction. Concurrent chemotherapy was not given. Adjuvant chemotherapy was given after CSI. Spinal fields were interrupted in 73.1% of patients. Cause of first interruption was leucopenia in 92.1%, thrombocytopenia in 2.6%, and both in 5.3%. Median number of fractions at first interruption was 8.5, with 63.2% of interruptions before 10 fractions. Median duration for hematological recovery was 10 days. Half of the patients had at least two interruptions, and 20% subsequently developed grade III toxicity. Overall treatment time >50 days was seen in 24.5% patients. On multivariate analysis, significant correlation with duration of delay was observed for pre-treatment hemoglobin (p = 0.018), number of fractions at first interruption, grade and duration of recovery of leucopenia (p 


Acute hematological toxicity with CSI is frequently under-reported. Even after interrupting spinal irradiation at grade 2 levels, 20% of patients developed grade III toxicity subsequently. Increasing OTT may lead to poorer survival. Frequent monitoring and timely intervention for acute hematological toxicity are recommended during CSI.

Clinical trial indentification

Legal entity responsible for the study





All authors have declared no conflicts of interest.