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Supratentorial PNET



Late Effects of Therapy

Late Effects of Radiation Therapy (RT):

  • Occur 90 days to many years after RT 

Late Effects depend very much on:

  • Age of the child at therapy:
    • The younger the child, the more pronounced the toxicity is likely to be
  • Dose of RT:
    • Higher dose associated with increased toxicity
  • RT treatment field extent:
    • Craniospinal RT more damaging than focal field
  • Concurrent chemotherapy increases toxicity

Supratentorial PNETs are generally treated with moderately high dose craniospinal RT, concurrent chemotherapy and require a "boost" of extra RT to supratentorial brain. As a group these patients are at risk for significant treatment related toxicity. The most devastating late effect of therapy is usually neurocognitive delay.


Summary of Late Effects after radiation therapy for Supratentorial PNETs:

Therapy Late Toxicity


RT (cranial portion of RT field) and boost to supratentorial brain

Neurocognitive problems:

  • Poor short term memory
  • Difficulty with executive function


  • Usually related to multiple long-term health problems and neurocognitive dysfunction

Hearing loss:

  • Direct RT related damage to the cochlea
  • Compounded often by previous cisplatin

Pituitary and hypothalamic dysfunction:

Increased risk for cerebrovascular events (strokes):

  • RT effect on cerebral vasculature

Increased risk of second neoplasms:


  • Lens of the eye very sensitive to RT

Sparse growth of scalp hair:

  • Especially within the region where "boost" of extra RT is given

Hypoplasia of cranial region:

  • Due to boost and cranial RT


RT (spinal portion of RT field)

Thyroid damage is very common due to the "exit"

dose of the spinal field:

Spinal damage from RT effect on spinal growth:

  • Short sitting height (and therefore total height)
  • Scoliosis and kyphosis of spine leading to pain
  • Increased risk of early spinal arthritis and osteoporosis


  • Exit dose from lower end of spinal field damages ovaries or testicles

Cardiac damage:

  • Valvular stenosis from exit RT exit dose (rare)

Damage to bone marrow reserve:

  • After craniospinal RT, it is very difficult to tolerate further intensive chemotherapy
  • Bone marrow reserve is permanently damaged


Summary of Late Effects after surgery for Supratentorial PNET:

Therapy Late Toxicity
Surgical resection of tumor Deficit depends on location of tumor


Summary of Late Effects after chemotherapy for Supratentorial PNET:

Therapy Late Toxicity

Cisplatin associated with:

  • High frequency hearing loss
  • With RT this may cause severe hearing impairment

Vincristine associated with:

  • Peripheral neuropathy

Alkylating agents associated with:

  • Infertility
  • Second malignancies



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