Originally published as JCO Early Release 10.1200/JCO.2008.18.6437 on March 9 2009

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Online Quality Control, Hyperfractionated Radiotherapy Alone and Reduced Boost Volume for Standard Risk Medulloblastoma: Long-Term Results of MSFOP 98

From the Centre Léon Bérard, Department of Radiotherapy; Centre Léon Bérard, Department of Unit of Biostatics and Evaluation of Therapeutics; Lyon University, Lyon; Institut Gustave Roussy, Department of Pediatric Oncology; Institut Gustave Roussy, Department of Radiotherapy, Villejuif; Centre Hospitalier Universitaire (CHU) de la Timone, Department of Pathology; Centre Alexis Vautrin Department of Radiotherapy, Nancy; CHU de la Timone, Department of Radiotherapy, Marseille; Centre Eugène Marquis, Department of Radiotherapy, Rennes; Centre Paul Papin, Department of Radiotherapy, Angers; Centre René Gauducheau, Department of Radiotherapy, Nantes; Centre Paul Strauss, Department of Radiotherapy, Strasbourg; Centre Hospitalo-Universitaire de Bordeaux, Department of Radiotherapy, Bordeaux; Hôpital Saint Jacques, Department of Radiotherapy, Besançon; Centre Hospitalier Universitaire, Department of Radiotherapy, Limoges; Centre Hospitalier Universitaire, Department of Radiotherapy, Tours; Centre Georges François Leclerc, Department of Radiotherapy, Dijon; Institut Curie, Department of Radiotherapy, Paris; and the Institut Claudius Regaud, Department of Radiotherapy, Toulouse, France.

Corresponding author: Christian Carrie, MD, Department of Radiotherapy, Centre Léon Bérard, 28 rue Laënnec, 69373 Lyon Cedex 08 France; e-mail: carrie{at}lyon.fnclcc.fr.

Purpose To determine event free and overall survival, and long-term cognitive sequelae of children with standard-risk medulloblastoma (SRM) treated with hyperfractionated radiotherapy, conformal reduced boost volume without chemotherapy, and online quality assurance.

Patients and Methods Forty-eight patients (age 5 to 18 years) were included in the Medulloblastoma-Société Française d'Oncologie Pédiatrique (MSFOP 98) protocol (December 1998 to October 2001). Patients received hyperfractionated radiotherapy (HFRT; 36 Gy, 1 Gy/fraction twice per day) to the craniospinal axis followed by a boost to the tumor bed (1.5-cm margin) to a dose of 68 Gy. Records of craniospinal irradiation were reviewed before treatment started. Neuropsychologic evaluations were done according to the protocol (1, 3, 5, and 7 years after irradiation). Cognitive outcomes were followed longitudinally with full-scale intelligence quotient (FSIQ) obtained with age-adapted Wechsler scales.

Results After a median follow-up of 77.7 months, 6-year overall survival (OS) and event-free survival (EFS) rates for the cohort were 78% (95% CI, 66% to 90%) and 75%, respectively (95% CI, 62% to 87%). Thanks to quality control, 14 major deviations were detected. Annual full scale IQ decline was 2 points over a 6-year period. Predicted change in FSIQ points per year was 2.15 (95% CI, –1.24 to 3.51) with an intercept (ie, predicted FSIQ) of 93.57 at baseline.

Conclusion HFRT protocol with conformal reduced boost and online quality control allows excellent long-term OS and EFS in the absence of chemotherapy. In addition, FSIQ drops seem to be less pronounced than previously reported with standard irradiation regimens.

Supported by a grant from the French Health Ministry PHRC 1997 and by a grant from Electricité de France – Commissariat à l'Energie Atomique to JG for neuropsychologic evaluations.

Presented in part at the 45th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Salt Lake City, UT, October 19-23, 2003; the 1st Annual Meeting of the Paediatric Radiation Oncology Society, Barcelona, Spain, June 26-28, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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