This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thomas, P. R. M. Articles by Kun, L. E. Search for Related Content PubMed PubMed Citation Articles by Thomas, P. R. M. Articles by Kun, L. E. Social Bookmarking                            What's this?

Low-Stage Medulloblastoma: Final Analysis of Trial Comparing Standard-Dose With Reduced-Dose Neuraxis Irradiation

From the Temple University Cancer Center; Children’s Hospital of Philadelphia, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; Pediatric Oncology Group Statistical Office, Gainesville; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; St Jude Children’s Research Hospital, Memphis, TN; Children’s Hospital of Michigan, Detroit, MI; Beth Israel Medical Center; New York University Medical Center, New York; Roswell Park Cancer Institute, Buffalo, NY; Children’s National Medical Center, Washington, DC; Joint Center for Radiation Therapy, Boston, MA; University of Iowa Hospital and Clinics, Iowa City, IA; Children’s Hospital of Los Angeles, Los Angeles; Long Beach Memorial Medical Center, Long Beach; Children’s Cancer Group, Arcadia, CA; Duke University Medical Center, Durham, NC; Washington University Medical Center, St Louis, MO; and the Pediatric Oncology Group, Chicago, IL.

Address reprint requests to Patrick R.M. Thomas, MD, (#8631), c/o: Pediatric Oncology Group, 645 North Michigan Ave, Ste 910, Chicago, IL 60611; email pthomasmd{at}aol.com

PURPOSE: To evaluate prospectively the effects on survival, relapse-free survival, and patterns of relapse of reduced-dose (23.4 Gy in 13 fractions) compared with standard-dose (36 Gy in 20 fractions) neuraxis irradiation in patients 3 to 21 years of age with low-stage medulloblastoma, minimal postoperative residual disease, and no evidence of neuraxis disease.

PATIENTS AND METHODS: The Pediatric Oncology Group and Children’s Cancer Group randomized 126 patients to the study. All patients received posterior fossa irradiation to a total dose of 54 Gy in addition to the neuraxis treatment. Patients were staged postoperatively with contrast-enhanced cranial computed tomography, myelography, and CSF cytology. Of the registered patients, 38 were ineligible.

RESULTS: The planned interim analysis that resulted in closure of the protocol showed that patients randomized to the reduced neuraxis treatment had increased frequency of relapse. In the final analysis, eligible patients receiving standard-dose neuraxis irradiation had 67% event-free survival (EFS) at 5 years (SE = 7.4%), whereas eligible patients receiving reduced-dose neuraxis irradiation had 52% event-free survival at 5 years (SE = 7.7%) (P = .080). At 8 years, the respective EFS proportions were also 67% (SE = 8.8%) and 52% (SE = 11%) (P = .141). These data confirm the original one-sided conclusions but suggest that differences are less marked with time.

CONCLUSION: Reduced-dose neuraxis irradiation (23.4 Gy) is associated with increased risk of early relapse, early isolated neuraxis relapse, and lower 5-year EFS and overall survival than standard irradiation (36 Gy). The 5-year EFS for patients receiving standard-dose irradiation is suboptimal, and improved techniques and/or therapies are needed to improve ultimate outcome. Chemotherapy may contribute to this improvement.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. Dhall Medulloblastoma J Child Neurol, November 1, 2009; 24(11): 1418 - 1430. [Abstract] [PDF]

				C. Carrie, J. Grill, D. Figarella-Branger, V. Bernier, L. Padovani, J. L. Habrand, M. Benhassel, M. Mege, M. Mahe, P. Quetin, et al. Online Quality Control, Hyperfractionated Radiotherapy Alone and Reduced Boost Volume for Standard Risk Medulloblastoma: Long-Term Results of MSFOP 98 J. Clin. Oncol., April 10, 2009; 27(11): 1879 - 1883. [Abstract] [Full Text] [PDF]

				R. J. Packer and G. Vezina Management of and Prognosis With Medulloblastoma: Therapy at a Crossroads Arch Neurol, November 1, 2008; 65(11): 1419 - 1424. [Abstract] [Full Text] [PDF]

				B Pizer and S Clifford Medulloblastoma: new insights into biology and treatment Arch. Dis. Child. Ed. Pract., October 1, 2008; 93(5): 137 - 144. [Full Text] [PDF]

				N. G. Gottardo and A. Gajjar Chemotherapy for Malignant Brain Tumors of Childhood J Child Neurol, October 1, 2008; 23(10): 1149 - 1159. [Abstract] [PDF]

				I. F. Pollack Diagnostic and Therapeutic Stratification of Childhood Brain Tumors: Implications for Translational Research J Child Neurol, October 1, 2008; 23(10): 1179 - 1185. [Abstract] [PDF]

				T. J. MacDonald Aggressive Infantile Embryonal Tumors J Child Neurol, October 1, 2008; 23(10): 1195 - 1204. [Abstract] [PDF]

				K. Yasuda, H. Taguchi, Y. Sawamura, J. Ikeda, H. Aoyama, K. Fujieda, N. Ishii, M. Kashiwamura, Y. Iwasaki, and H. Shirato Low-dose Craniospinal Irradiation and Ifosfamide, Cisplatin and Etoposide for Non-metastatic Embryonal Tumors in the Central Nervous System Jpn. J. Clin. Oncol., July 1, 2008; 38(7): 486 - 492. [Abstract] [Full Text] [PDF]

				A. Rossi, V. Caracciolo, G. Russo, K. Reiss, and A. Giordano Medulloblastoma: From Molecular Pathology to Therapy Clin. Cancer Res., February 15, 2008; 14(4): 971 - 976. [Abstract] [Full Text] [PDF]

				S. L. Palmer, W. E. Reddick, and A. Gajjar Understanding the Cognitive Impact on Children Who are Treated for Medulloblastoma J. Pediatr. Psychol., October 1, 2007; 32(9): 1040 - 1049. [Abstract] [Full Text] [PDF]

				R. J. Packer, A. Gajjar, G. Vezina, L. Rorke-Adams, P. C. Burger, P. L. Robertson, L. Bayer, D. LaFond, B. R. Donahue, M. H. Marymont, et al. Phase III Study of Craniospinal Radiation Therapy Followed by Adjuvant Chemotherapy for Newly Diagnosed Average-Risk Medulloblastoma J. Clin. Oncol., September 1, 2006; 24(25): 4202 - 4208. [Abstract] [Full Text] [PDF]

				A. Kovanlikaya, A. Panigrahy, M. D. Krieger, I. Gonzalez-Gomez, N. Ghugre, J. G. McComb, F. H. Gilles, M. D. Nelson, and S. Bluml Untreated Pediatric Primitive Neuroectodermal Tumor in Vivo: Quantitation of Taurine with MR Spectroscopy Radiology, September 1, 2005; 236(3): 1020 - 1025. [Abstract] [Full Text] [PDF]

				R. K. Mulhern, S. L. Palmer, T. E. Merchant, D. Wallace, M. Kocak, P. Brouwers, K. Krull, M. Chintagumpala, R. Stargatt, D. M. Ashley, et al. Neurocognitive Consequences of Risk-Adapted Therapy for Childhood Medulloblastoma J. Clin. Oncol., August 20, 2005; 23(24): 5511 - 5519. [Abstract] [Full Text] [PDF]

				V. Oyharcabal-Bourden, C. Kalifa, J.C. Gentet, D. Frappaz, C. Edan, P. Chastagner, E. Sariban, A. Pagnier, A. Babin, F. Pichon, et al. Standard-Risk Medulloblastoma Treated by Adjuvant Chemotherapy Followed by Reduced-Dose Craniospinal Radiation Therapy: A French Society of Pediatric Oncology Study J. Clin. Oncol., July 20, 2005; 23(21): 4726 - 4734. [Abstract] [Full Text] [PDF]

				Y. Liu, Y. Zhu, L. Gao, G. Xu, J. Yi, X. Liu, and Y. Li Radiation Treatment for Medulloblastoma: a Review of 64 Cases at a Single Institute Jpn. J. Clin. Oncol., March 1, 2005; 35(3): 111 - 115. [Abstract] [Full Text] [PDF]

				S. K. Patel and B. Carlson-Green Commentary: Toward Greater Integration and Specificity in Conceptual Models of Neurocognitive Functioning in Childhood Cancer Survivors J. Pediatr. Psychol., January 1, 2005; 30(1): 85 - 88. [Full Text] [PDF]

				W. Xu, A. Janss, R. J. Packer, P. Phillips, J. Goldwein, and T. Moshang Jr. Endocrine outcome in children with medulloblastoma treated with 18 Gy of craniospinal radiation therapy Neuro-oncol, April 1, 2004; 6(2): 113 - 118. [Abstract] [PDF]

				A. Fernandez-Teijeiro, R. A. Betensky, L. M. Sturla, J. Y.H. Kim, P. Tamayo, and S. L. Pomeroy Combining Gene Expression Profiles and Clinical Parameters for Risk Stratification in Medulloblastomas J. Clin. Oncol., March 15, 2004; 22(6): 994 - 998. [Abstract] [Full Text] [PDF]

				S. L. Wolden, I. J. Dunkel, M. M. Souweidane, L. Happersett, Y. Khakoo, K. Schupak, D. Lyden, and S. A. Leibel Patterns of Failure Using a Conformal Radiation Therapy Tumor Bed Boost for Medulloblastoma J. Clin. Oncol., August 15, 2003; 21(16): 3079 - 3083. [Abstract] [Full Text] [PDF]