• Roger E Taylor, Andrew J Howman, Keith Wheatley, Elena E Brogden, Bridget Large, Michael J Gibson, Keith Robson, Dipayan Mitra, Frank Saran, Antony Michalski, and Barry L Pizer.
• Swansea University, UK. Electronic address: Roger.Taylor@Wales.nhs.uk.
• Radiother Oncol. 2014 Apr 1; 111 (1): 41-6.

Background And PurposeTo evaluate feasibility and toxicity of Hyperfractionated Accelerated Radiotherapy (HART) 1.24Gy b.i.d. followed by chemotherapy for M1-3 Medulloblastoma (MB). The aim of HART was to use hyperfractionation to improve therapeutic ratio combined with acceleration to minimise tumour cell repopulation during radiotherapy (RT).Materials And MethodsBetween February 2002 and May 2008, 34 eligible patients (22 male, 12 female) aged 3-15years (median 7) with metastatic MB (M1-9; M2-3, M3-22) received HART with a craniospinal radiotherapy (CSRT) dose of 39.68Gy followed by 22.32Gy boost to the whole posterior fossa and 9.92Gy metastatic boosts. The 8th and subsequent patients received vincristine (VCR) 1.5mg/m(2) weekly×8 doses over 8weeks starting during the 1st week of RT. Maintenance chemotherapy comprised 8 six-weekly cycles of VCR 1.5mg/m(2) weekly×3, CCNU 75mg/m(2) and cisplatin 70mg/m(2).ResultsMedian duration of HART was 34days (range 31-38). Grade 3-4 toxicities included mucositis (8), nausea (10), anaemia (5), thrombocytopaenia (2), leucopaenia (24). With 4.5-year median follow-up, 3-year EFS and OS were 59% and 71%, respectively. Of 10 relapses, 1 was outside the central nervous system (CNS), 1 posterior fossa alone and 8 leptomeningeal with 3 also associated with posterior fossa.ConclusionHART with or without VCR was well tolerated and may have a place in the multi-modality management of high-risk MB.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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