A Phase II Study of Preradiotherapy Chemotherapy Followed by Hyperfractionated Radiotherapy for Newly Diagnosed High-Risk Medulloblastoma/Primitive Neuroectodermal Tumor: A Report From the Children's Oncology Group (CCG 9931)

Journal Article · Wed Jul 15 04:00:00 EDT 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.09.019· OSTI ID:21276889

Allen, Jeffrey ^[1]; Donahue, Bernadine ^[2]; Mehta, Minesh ^[3]; Miller, Douglas C ^[1]; Rorke, Lucy B ^[4]; Jakacki, Regina ^[5]; Robertson, Patricia ^[6]; Sposto, Richard ^[7]; Holmes, Emi ^[8]; Vezina, Gilbert ^[9]; Muraszko, Karin ^[10]; Puccetti, Diane ^[11]; Prados, Michael ^[12]; Chan, K -W ^[13]

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1. Departments of Pediatrics and Pathology, New York University Medical Center, New York, NY (United States)
2. Department of Radiation Oncology, Maimonides Medical Center, Brooklyn, NY (United States)
3. Department of Radiation Oncology, Children's Hospital, Madison, WI (United States)
4. Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA (United States)
5. Department of Pediatric Oncology, Children's Hospital, Pittsburgh, PA (United States)
6. Department of Neurology, C.S. Mott Children's Hospital, Ann Arbor, MI (United States)
7. Departments of Preventive Medicine and Pediatrics (Children's Hospital Los Angeles), Keck School of Medicine at University of Southern California, Los Angeles, CA (United States)
8. Children's Oncology Group Operations Office, Arcadia, CA (United States)
9. Department of Radiology, National Children's Medical Center, Washington, DC (United States)
10. Department of Neurosurgery, University of Michigan, Ann Arbor, MI (United States)
11. University of Wisconsin Children's Hospital, Madison, WI (United States)
12. Department of Neurosurgery, University of California, San Francisco, CA (United States)
13. Methodist Children's Hospital of South Texas, San Antonio, TX (United States)

Purpose: To verify feasibility and monitor progression-free survival and overall survival in children with high-risk medulloblastoma and noncerebellar primitive neuroectodermal tumors (PNETs) treated in a Phase II study with preradiotherapy chemotherapy (CHT) followed by high-dose, hyperfractionated craniospinal radiotherapy (CSRT). Methods and Materials: Eligibility criteria included age >3 years at diagnosis, medulloblastoma with either high M stage and/or >1.5 cm{sup 2} postoperative residual disease, and all patients with noncerebellar PNET. Treatment was initiated with five alternating monthly cycles of CHT (A [cisplatin, cyclophosphamide, etoposide, and vincristine], B [carboplatin and etoposide], A, B, and A) followed by hyperfractionated CSRT (40 Gy) with a boost to the primary tumor (72 Gy) given in twice-daily 1-Gy fractions. Results: The valid study group consisted of 124 patients whose median age at diagnosis was 7.8 years. Eighty-four patients (68%) completed the entire protocol according to study guidelines (within 9 months), and the median time to complete CSRT was 1.6 months. Major reasons for failure to complete CHT included progressive disease (17%) and toxic death (2.4%). The 5-year progression-free survival and overall survival rates were 43% {+-} 5% and 52% {+-} 5%, respectively. No significant differences were detected in subset analysis related to response to CHT, site of primary tumor, postoperative residual disease, or M stage. Conclusions: The feasibility of this intensive multimodality protocol was confirmed, and response to pre-RT CHT did not impact on survival. Survival data from this protocol can not be compared with data from other studies, given the protocol design.

• OSTI ID: 21276889
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 74; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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