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)
- Departments of Pediatrics and Pathology, New York University Medical Center, New York, NY (United States)
- Department of Radiation Oncology, Maimonides Medical Center, Brooklyn, NY (United States)
- Department of Radiation Oncology, Children's Hospital, Madison, WI (United States)
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA (United States)
- Department of Pediatric Oncology, Children's Hospital, Pittsburgh, PA (United States)
- Department of Neurology, C.S. Mott Children's Hospital, Ann Arbor, MI (United States)
- 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)
- Children's Oncology Group Operations Office, Arcadia, CA (United States)
- Department of Radiology, National Children's Medical Center, Washington, DC (United States)
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI (United States)
- University of Wisconsin Children's Hospital, Madison, WI (United States)
- Department of Neurosurgery, University of California, San Francisco, CA (United States)
- 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, Vol. 74, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2008.09.019; PII: S0360-3016(08)03472-X; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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