title: Standard-risk medulloblastoma treated by adjuvant chemotherapy followed by reduced-dose craniospinal radiation therapy: a French Society of Pediatric Oncology Study.
abstract: OBJECTIVE
  The primary objective of this study was to decrease the late effects of prophylactic radiation without reducing survival in standard-risk childhood medulloblastoma.
  
  
  METHODS
  Inclusion criteria were as follows: children between the ages of 3 and 18 years with total or subtotal tumor resection, no metastasis, and negative postoperative lumbar puncture CSF cytology. Two courses of eight drugs in 1 day followed by two courses of etoposide plus carboplatin (500 and 800 mg/m(2) per course, respectively) were administered after surgery. Radiation therapy had to begin 90 days after surgery. Delivered doses were 55 Gy to the posterior fossa and 25 Gy to the brain and spinal canal.
  
  
  RESULTS
  Between November 1991 and June 1998, 136 patients (median age, 8 years; median follow-up, 6.5 years) were included. The overall survival rate and 5-year recurrence-free survival rate were 73.8% +/- 7.6% and 64.8% +/- 8.1%, respectively. Radiologic review showed that 4% of patients were wrongly included. Review of radiotherapy technical files demonstrated a correlation between the presence of a major protocol deviation and treatment failure. The 5-year recurrence-free survival rate of patients included in this study with all optimal quality controls of histology, radiology, and radiotherapy was 71.8% +/- 10.5%. In terms of sequelae, 31% of patients required growth hormone replacement therapy and 25% required special schooling.
  
  
  CONCLUSIONS
  Reduced-dose craniospinal radiation therapy can be proposed in standard-risk medulloblastoma provided staging and radiation therapy are performed under optimal conditions.
authors: Institut Curie, Paris, France.
authors: V
authors: V
authors: Oyharcabal-Bourden
authors: C
authors: C
authors: Kalifa
authors: J C
authors: JC
authors: Gentet
authors: D
authors: D
authors: Frappaz
authors: C
authors: C
authors: Edan
authors: P
authors: P
authors: Chastagner
authors: E
authors: E
authors: Sariban
authors: A
authors: A
authors: Pagnier
authors: A
authors: A
authors: Babin
authors: F
authors: F
authors: Pichon
authors: S
authors: S
authors: Neuenschwander
authors: M
authors: M
authors: Vinchon
authors: D
authors: D
authors: Bours
authors: V
authors: V
authors: Mosseri
authors: C
authors: C
authors: Le Gales
authors: M
authors: M
authors: Ruchoux
authors: C
authors: C
authors: Carrie
authors: F
authors: F
authors: Doz
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001921:Brain / Q000528:radiation effects; D016190:Carboplatin / Q000008:administration & dosage; D002528:Cerebellar Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013115:Spinal Canal / Q000528:radiation effects; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide; D016190:Carboplatin