Conformal radiotherapy, reduced boost volume, hyperfractionated radiotherapy, and online quality control in standard-risk medulloblastoma without chemotherapy: results of the French M-SFOP 98 protocol.
OBJECTIVE
Between December 1998 and October 2001, patients <19 years old were treated for standard-risk medulloblastoma according to the Medulloblastome-Société Française d'Oncologie Pédiatrique 1998 (M-SFOP 98) protocol. Patients received hyperfractionated radiotherapy (36 Gy in 36 fractions) to the craniospinal axis, a boost with conformal therapy restricted to the tumor bed (to a total dose of 68 Gy in 68 fractions), and no chemotherapy. Records of craniospinal irradiation were reviewed before treatment start.


RESULTS
A total of 48 patients were considered assessable. With a median follow-up of 45.7 months, the overall survival and progression-free survival rate at 3 years was 89% and 81%, respectively. Fourteen major deviations were detected and eight were corrected. No relapses occurred in the frontal region and none occurred in the posterior fossa outside the boost volume. Nine patients were available for volume calculation without reduction of the volume irradiated. We observed a reduction in the subtentorial volume irradiated to >60 Gy, but a slight increase in the volume irradiated to 40 Gy. No decrease in intelligence was observed in the 22 children tested during the first 2 years.


CONCLUSIONS
This hyperfractionated radiotherapy protocol with a reduced boost volume and without chemotherapy was not associated with early relapses in children. Moreover, intellectual function seemed to be preserved. These results are promising.
Carrie
Christian
C
Department of Radiotherapy, Centre Léon Bérard, Lyon, France. carrie@lyon.fnclcc.fr
Muracciole
Xavier
X
Gomez
Frédéric
F
Habrand
Jean-Louis
JL
Benhassel
Mohamed
M
Mege
Martine
M
Mahé
Marc
M
Quetin
Philippe
P
Maire
Jean Philippe
JP
Soum
Françoise
F
Baron
Marie Helene
MH
Clavere
Pierre
P
Chapet
Sophie
S
Gaci
Zineb
Z
Kolodie
Helene
H
Maingon
Philippe
P
Vie
Bernard
B
Bernier
Valérie
V
Alapetite
Claire
C
Hoffstetter
Sylvette
S
Grill
Jacques
J
Lafay
Frédéric
F
D000293:Adolescent; D002528:Cerebellar Neoplasms / Q000532:radiotherapy*; D002648:Child; D003071:Cognition; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005602:France; D006801:Humans; D008527:Medulloblastoma / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local; D010865:Pilot Projects; D011786:Quality Control; D020266:Radiotherapy, Conformal / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome