Journal of Clinical Oncology, Vol 17, Issue 7
(July), 1999: 2127
© 1999 American Society for Clinical Oncology
Treatment of Children With Medulloblastomas With Reduced-Dose Craniospinal Radiation Therapy and Adjuvant Chemotherapy: A Children's Cancer Group Study
Roger J. Packer,
Joel Goldwein,
H. Stacy Nicholson,
L. Gilbert Vezina,
Jeffrey C. Allen,
M. Douglas Ris,
Karin Muraszko,
Lucy B. Rorke,
William M. Wara,
Bruce H. Cohen,
James M. Boyett
From the Departments of Neurology and Radiology, Children's National Medical Center, Washington, DC; Departments of Neurology, Radiology, and Pediatrics, The George Washington University, Washington, DC; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA; Department of Hematology-Oncology, University of Oregon, Portland, OR; Department of Neurology, Beth Israel Medical Center, New York, NY; Department of Psychology, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH; Department of Neurosurgery, University of Michigan, Ann Arbor, MI; Department of Pathology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA; Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA; Department of Neurology, Cleveland Clinic, Cleveland, OH; and Department of Biostatistics and Epidemiology, St. Jude Children's Research Hospital, Memphis, TN.
Address reprint requests to Roger J. Packer, MD, Children's Cancer Group, PO Box 60012, Arcadia, CA 91066-6012; email rpacker{at}cnmc.org
PURPOSE: Medulloblastoma is the most common malignant brain tumor of childhood. After treatment with surgery and radiation therapy, approximately 60% of children with medulloblastoma are alive and free of progressive disease 5 years after diagnosis, but many have significant neurocognitive sequelae. This study was undertaken to determine the feasibility and efficacy of treating children with nondisseminated medulloblastoma with reduced-dose craniospinal radiotherapy plus adjuvant chemotherapy.
PATIENTS AND METHODS: Over a 3-year period, 65 children between 3 and 10 years of age with nondisseminated medulloblastoma were treated with postoperative, reduced-dose craniospinal radiation therapy (23.4 Gy) and 55.8 Gy of local radiation therapy. Adjuvant vincristine chemotherapy was administered during radiotherapy, and lomustine, vincristine, and cisplatin chemotherapy was administered during and after radiation.
RESULTS: Progression-free survival was 86% ± 4% at 3 years and 79% ± 7% at 5 years. Sites of relapse for the14 patients who developed progressive disease included the local tumor site alone in two patients, local tumor site and disseminated disease in nine, and nonprimary sites in three. Brainstem involvement did not adversely affect outcome. Therapy was relatively well tolerated; however, the dose of cisplatin had to be modified in more than 50% of patients before the completion of treatment. One child died of pneumonitis and sepsis during treatment.
CONCLUSION: These overall survival rates compare favorably to those obtained in studies using full-dose radiation therapy alone or radiation therapy plus chemotherapy. The results suggest that reduced-dose craniospinal radiation therapy and adjuvant chemotherapy during and after radiation is a feasible approach for children with nondisseminated medulloblastoma.
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