Treatment of patients of high-risk group of medulloblastoma with the adjuvant lomustine, cisplatin, and vincristine chemotherapy.
The prognosis of children with medulloblastoma, primitive neuroectodermal tumor of cerebella, is poor especially in case of disseminated disease. Bad outcome of this disease encouraged the investigators to look for new more effective and safer ways of medulloblastoma treatment that would be able to improve the prognosis and quality of live for children with medulloblastoma. Adjuvant chemotherapy administered after radiotherapy prolongs the time to progression as well as overall survival for high-risk group of medulloblastoma patients, while such results vary little in standard-risk medulloblastoma group.


OBJECTIVE
To evaluate effectiveness of adjuvant chemotherapy while treating high-risk medulloblastoma patients.


METHODS
A total of 18 patients with disseminated and non-totally removed medulloblastoma admitted to high-risk group aged from 3 to 18 years were enrolled in this study. Nine of these patients were treated by radiotherapy alone and the adjuvant chemotherapy with CCNU (lomustine), cisplatinum, and vincristine after radiotherapy was administered to the other nine patients.


RESULTS
Full response was determined in all patients of adjuvant chemotherapy group and only in 3 children out of 9 in radiotherapy group (33.3%) (p<0.01). The rate of the relapse was 100% in radiotherapy and 11.1% in adjuvant chemotherapy group that differed statistically reliably in both group patients (p<0.001). Mean time to progression among patients of radiotherapy group was 9+/-2 months and 47+/-8 months among of the patients of adjuvant chemotherapy group (p<0.01). Two years free to progression survival in adjuvant chemotherapy group was 88.9%, in radiotherapy group - 0%. Two-year overall survival in these groups was 71.1 and 22.2%, respectively (p<0.01).


CONCLUSIONS
With this research we proved that adjuvant chemotherapy, prescribed after standard radial (craniospinal and local) treatment, statistically reliably improves survival indices of patients from high risk group and has to be prescribed to all patients from this risk group.
Rutkauskiene
Giedre
G
Clinic of Children's Diseases, Kaunas University of Medicine, Kaunas, Lithuania. giedre.rutkauskiene@takas.lt
Labanauskas
Liutauras
L
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002531:Cerebellum / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use
D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D000972:Antineoplastic Agents, Phytogenic; D014750:Vincristine; D008130:Lomustine; D002945:Cisplatin