title: Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy: A Children's Cancer Group Study.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Neurology and Radiology, Children's National Medical Center, Washington, DC, USA. rpacker@cnmc.org
authors.forename: R J
authors.initials: RJ
authors.lastname: Packer
authors.forename: J
authors.initials: J
authors.lastname: Goldwein
authors.forename: H S
authors.initials: HS
authors.lastname: Nicholson
authors.forename: L G
authors.initials: LG
authors.lastname: Vezina
authors.forename: J C
authors.initials: JC
authors.lastname: Allen
authors.forename: M D
authors.initials: MD
authors.lastname: Ris
authors.forename: K
authors.initials: K
authors.lastname: Muraszko
authors.forename: L B
authors.initials: LB
authors.lastname: Rorke
authors.forename: W M
authors.initials: WM
authors.lastname: Wara
authors.forename: B H
authors.initials: BH
authors.lastname: Cohen
authors.forename: J M
authors.initials: JM
authors.lastname: Boyett
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008527:Medulloblastoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011829:Radiation Dosage; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D008130:Lomustine; D002945:Cisplatin