• Int. J. Radiat. Oncol. Biol. Phys. · Jul 2009

    Multicenter Study

    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).

    • Jeffrey Allen, Bernadine Donahue, Minesh Mehta, Douglas C Miller, Lucy B Rorke, Regina Jakacki, Patricia Robertson, Richard Sposto, Emi Holmes, Gilbert Vezina, Karin Muraszko, Diane Puccetti, Michael Prados, and Ka-Wah Chan.
    • Departments of Pediatrics and Pathology, New York University Medical Center, New York, NY 10016, USA. Jeffrey.allen@nyumc.org
    • Int. J. Radiat. Oncol. Biol. Phys. 2009 Jul 15; 74 (4): 1006-11.

    PurposeTo 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 MaterialsEligibility criteria included age >3 years at diagnosis, medulloblastoma with either high M stage and/or >1.5 cm(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.ResultsThe 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.ConclusionsThe 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.

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