Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy: A Children's Cancer Group study

Roger J. Packer, Joel Goldwein, H. Stacy Nicholson, L. Gilbert Vezina, Jeffrey C. Allen, M. Douglas Ris, Karin Muraszko, Lucy B. Rorke, William M. Wara, Bruce H. Cohen, James M. Boyett

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Abstract

Purpose: Medulloblastoma is the most common malignant brain tumor of childhood. After treatment with surgery and radiation therapy, approximately 60% of children with medulloblastoma are alive and free of progressive disease 5 years after diagnosis, but many have significant neurocognitive sequelae. This study was undertaken to determine the feasibility and efficacy of treating children with nondisseminated medulloblastoma with reduced-dose craniospinal radiotherapy plus adjuvant chemotherapy. Patients and Methods: Over a 3-year period, 65 children between 3 and 10 years of age with nondisseminated medulloblastoma were treated with postoperative, reduced- dose craniospinal radiation therapy (23.4 Gy) and 55.8 Gy of local radiation therapy. Adjuvant vincristine chemotherapy was administered during radiotherapy, and lomustine, vincristine, and cisplatin chemotherapy was administered during and after radiation. Results: Progression-free survival was 86% ± 4% at 3 years and 79% ± 7% at 5 years. Sites of relapse for the 14 patients who developed progressive disease included the local tumor site alone in two patients, local tumor site and disseminated disease in nine, and nonprimary sites in three. Brainstem involvement did not adversely affect outcome. Therapy was relatively well tolerated; however, the dose of cisplatin had to be modified in more than 50% of patients before the completion of treatment. One child died of pneumonitis and sepsis during treatment. Conclusion: These overall survival rates compare favorably to those obtained in studies using full-dose radiation therapy alone or radiation therapy plus chemotherapy. The results suggest that reduced-dose craniospinal radiation therapy and adjuvant chemotherapy during and after radiation is a feasible approach for children with nondisseminated medulloblastoma.

Original languageEnglish (US)
Pages (from-to)2127-2136
Number of pages10
JournalJournal of Clinical Oncology
Volume17
Issue number7
StatePublished - 1999
Externally publishedYes

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Medulloblastoma
Adjuvant Chemotherapy
Radiotherapy
Neoplasms
Vincristine
Therapeutics
Cisplatin
Lomustine
Radiation
Radiation Dosage
Drug Therapy
Brain Neoplasms
Brain Stem
Disease-Free Survival
Sepsis
Pneumonia
Survival Rate
Recurrence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Packer, R. J., Goldwein, J., Nicholson, H. S., Vezina, L. G., Allen, J. C., Ris, M. D., ... Boyett, J. M. (1999). Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy: A Children's Cancer Group study. Journal of Clinical Oncology, 17(7), 2127-2136.

Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy : A Children's Cancer Group study. / Packer, Roger J.; Goldwein, Joel; Nicholson, H. Stacy; Vezina, L. Gilbert; Allen, Jeffrey C.; Ris, M. Douglas; Muraszko, Karin; Rorke, Lucy B.; Wara, William M.; Cohen, Bruce H.; Boyett, James M.

In: Journal of Clinical Oncology, Vol. 17, No. 7, 1999, p. 2127-2136.

Research output: Contribution to journalArticle

Packer, RJ, Goldwein, J, Nicholson, HS, Vezina, LG, Allen, JC, Ris, MD, Muraszko, K, Rorke, LB, Wara, WM, Cohen, BH & Boyett, JM 1999, 'Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy: A Children's Cancer Group study', Journal of Clinical Oncology, vol. 17, no. 7, pp. 2127-2136.
Packer, Roger J. ; Goldwein, Joel ; Nicholson, H. Stacy ; Vezina, L. Gilbert ; Allen, Jeffrey C. ; Ris, M. Douglas ; Muraszko, Karin ; Rorke, Lucy B. ; Wara, William M. ; Cohen, Bruce H. ; Boyett, James M. / Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy : A Children's Cancer Group study. In: Journal of Clinical Oncology. 1999 ; Vol. 17, No. 7. pp. 2127-2136.
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abstract = "Purpose: Medulloblastoma is the most common malignant brain tumor of childhood. After treatment with surgery and radiation therapy, approximately 60{\%} of children with medulloblastoma are alive and free of progressive disease 5 years after diagnosis, but many have significant neurocognitive sequelae. This study was undertaken to determine the feasibility and efficacy of treating children with nondisseminated medulloblastoma with reduced-dose craniospinal radiotherapy plus adjuvant chemotherapy. Patients and Methods: Over a 3-year period, 65 children between 3 and 10 years of age with nondisseminated medulloblastoma were treated with postoperative, reduced- dose craniospinal radiation therapy (23.4 Gy) and 55.8 Gy of local radiation therapy. Adjuvant vincristine chemotherapy was administered during radiotherapy, and lomustine, vincristine, and cisplatin chemotherapy was administered during and after radiation. Results: Progression-free survival was 86{\%} ± 4{\%} at 3 years and 79{\%} ± 7{\%} at 5 years. Sites of relapse for the 14 patients who developed progressive disease included the local tumor site alone in two patients, local tumor site and disseminated disease in nine, and nonprimary sites in three. Brainstem involvement did not adversely affect outcome. Therapy was relatively well tolerated; however, the dose of cisplatin had to be modified in more than 50{\%} of patients before the completion of treatment. One child died of pneumonitis and sepsis during treatment. Conclusion: These overall survival rates compare favorably to those obtained in studies using full-dose radiation therapy alone or radiation therapy plus chemotherapy. The results suggest that reduced-dose craniospinal radiation therapy and adjuvant chemotherapy during and after radiation is a feasible approach for children with nondisseminated medulloblastoma.",
author = "Packer, {Roger J.} and Joel Goldwein and Nicholson, {H. Stacy} and Vezina, {L. Gilbert} and Allen, {Jeffrey C.} and Ris, {M. Douglas} and Karin Muraszko and Rorke, {Lucy B.} and Wara, {William M.} and Cohen, {Bruce H.} and Boyett, {James M.}",
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T1 - Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy

T2 - A Children's Cancer Group study

AU - Packer, Roger J.

AU - Goldwein, Joel

AU - Nicholson, H. Stacy

AU - Vezina, L. Gilbert

AU - Allen, Jeffrey C.

AU - Ris, M. Douglas

AU - Muraszko, Karin

AU - Rorke, Lucy B.

AU - Wara, William M.

AU - Cohen, Bruce H.

AU - Boyett, James M.

PY - 1999

Y1 - 1999

N2 - Purpose: Medulloblastoma is the most common malignant brain tumor of childhood. After treatment with surgery and radiation therapy, approximately 60% of children with medulloblastoma are alive and free of progressive disease 5 years after diagnosis, but many have significant neurocognitive sequelae. This study was undertaken to determine the feasibility and efficacy of treating children with nondisseminated medulloblastoma with reduced-dose craniospinal radiotherapy plus adjuvant chemotherapy. Patients and Methods: Over a 3-year period, 65 children between 3 and 10 years of age with nondisseminated medulloblastoma were treated with postoperative, reduced- dose craniospinal radiation therapy (23.4 Gy) and 55.8 Gy of local radiation therapy. Adjuvant vincristine chemotherapy was administered during radiotherapy, and lomustine, vincristine, and cisplatin chemotherapy was administered during and after radiation. Results: Progression-free survival was 86% ± 4% at 3 years and 79% ± 7% at 5 years. Sites of relapse for the 14 patients who developed progressive disease included the local tumor site alone in two patients, local tumor site and disseminated disease in nine, and nonprimary sites in three. Brainstem involvement did not adversely affect outcome. Therapy was relatively well tolerated; however, the dose of cisplatin had to be modified in more than 50% of patients before the completion of treatment. One child died of pneumonitis and sepsis during treatment. Conclusion: These overall survival rates compare favorably to those obtained in studies using full-dose radiation therapy alone or radiation therapy plus chemotherapy. The results suggest that reduced-dose craniospinal radiation therapy and adjuvant chemotherapy during and after radiation is a feasible approach for children with nondisseminated medulloblastoma.

AB - Purpose: Medulloblastoma is the most common malignant brain tumor of childhood. After treatment with surgery and radiation therapy, approximately 60% of children with medulloblastoma are alive and free of progressive disease 5 years after diagnosis, but many have significant neurocognitive sequelae. This study was undertaken to determine the feasibility and efficacy of treating children with nondisseminated medulloblastoma with reduced-dose craniospinal radiotherapy plus adjuvant chemotherapy. Patients and Methods: Over a 3-year period, 65 children between 3 and 10 years of age with nondisseminated medulloblastoma were treated with postoperative, reduced- dose craniospinal radiation therapy (23.4 Gy) and 55.8 Gy of local radiation therapy. Adjuvant vincristine chemotherapy was administered during radiotherapy, and lomustine, vincristine, and cisplatin chemotherapy was administered during and after radiation. Results: Progression-free survival was 86% ± 4% at 3 years and 79% ± 7% at 5 years. Sites of relapse for the 14 patients who developed progressive disease included the local tumor site alone in two patients, local tumor site and disseminated disease in nine, and nonprimary sites in three. Brainstem involvement did not adversely affect outcome. Therapy was relatively well tolerated; however, the dose of cisplatin had to be modified in more than 50% of patients before the completion of treatment. One child died of pneumonitis and sepsis during treatment. Conclusion: These overall survival rates compare favorably to those obtained in studies using full-dose radiation therapy alone or radiation therapy plus chemotherapy. The results suggest that reduced-dose craniospinal radiation therapy and adjuvant chemotherapy during and after radiation is a feasible approach for children with nondisseminated medulloblastoma.

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