• Colin Kennedy, Kim Bull, Mathilde Chevignard, David Culliford, Helmuth G Dörr, François Doz, Rolf-Dieter Kortmann, Birgitta Lannering, Maura Massimino, Aurora Navajas Gutiérrez, Stefan Rutkowski, Helen A Spoudeas, Gabriele Calaminus, and PNET4 study group of the Brain Tumour Group of The European branch of the International Society of Paediatric Oncology (SIOP-E).
• University of Southampton Faculty of Medicine and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom. Electronic address: crk1@soton.ac.uk.
• Int. J. Radiat. Oncol. Biol. Phys. 2014 Feb 1; 88 (2): 292-300.

PurposeTo compare quality of survival in "standard-risk" medulloblastoma after hyperfractionated radiation therapy of the central nervous system with that after standard radiation therapy, combined with a chemotherapy regimen common to both treatment arms, in the PNET4 randomised controlled trial.Methods And MaterialsParticipants in the PNET4 trial and their parents/caregivers in 7 participating anonymized countries completed standardized questionnaires in their own language on executive function, health status, behavior, health-related quality of life, and medical, educational, employment, and social information. Pre- and postoperative neurologic status and serial heights and weights were also recorded.ResultsData were provided by 151 of 244 eligible survivors (62%) at a median age at assessment of 15.2 years and median interval from diagnosis of 5.8 years. Compared with standard radiation therapy, hyperfractionated radiation therapy was associated with lower (ie, better) z-scores for executive function in all participants (mean intergroup difference 0.48 SDs, 95% confidence interval 0.16-0.81, P=.004), but health status, behavioral difficulties, and health-related quality of life z-scores were similar in the 2 treatment arms. Data on hearing impairment were equivocal. Hyperfractionated radiation therapy was also associated with greater decrement in height z-scores (mean intergroup difference 0.43 SDs, 95% confidence interval 0.10-0.76, P=.011).ConclusionsHyperfractionated radiation therapy was associated with better executive function and worse growth but without accompanying change in health status, behavior, or quality of life.Copyright © 2014 Elsevier Inc. All rights reserved.

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