Concomitant weekly vincristine and radiation followed by adjuvant vincristine and carboplatin in the treatment of high risk medulloblastoma: Ain Shams University Hospital and Sohag Cancer Center study.
OBJECTIVE
To evaluate survival, progression free survival (PFS) and toxicity of children with newly diagnosed high risk medulloblastoma who were treated with weekly vincristine concurrently during irradiation followed by adjuvant carboplatin and vincristine.


METHODS
High risk medulloblastoma patients with postoperative gross residual disease that was >1.5 cm2 and/or metastatic disease (M+) were planned to receive craniospinal irradiation (CSI) 36 Gy followed by boost to the posterior fossa for a total of 55.8 Gy. Concomitantly during radiation, patients received weekly vincristine 1.5 mg/m2. Six weeks after completion of radiation therapy, patients were scheduled on a regimen of weekly vincristine (1.5 mg/m2) and carboplatin (150 mg/m2) for 4 weeks, 3 weeks rest then another cycle for a total of 48 weeks.


RESULTS
The study included seventeen high risk medulloblastoma patients presented to Ain Shams University hospitals and Sohag Cancer Center between November 2001 and March 2005. Their median age was 8.4 years (range from 5 to 14 years), they were 12 males and 5 females. The overall survival at three year was 70.6% and the 3-year PFS was 58.8%. The 3-year overall survival for M+ patients was 50% Vs. 81.8% for M0 patients (p=0.04). The 3-year PFS was 50% for M+ patients Vs. 63.6% for M0 patients (p=0.15). The treatment was well tolerated. During CSI, 3 patients only (17.6%) developed grade 3 neutropenia. During adjuvant chemotherapy, the complications were more frequent and of deeper degree. Grade 3 and 4 neutropenia were observed in 5 patients (29%). One patient (6%) developed grade 3 peripheral neuropathy.


CONCLUSIONS
Our results show that the present chemotherapy and radiotherapeutic approach is able to improve overall survival and PFS in high risk patients with gross residual disease but not in patients with metastatic disease (M+) that may require more intensive therapy.
Salama
Mamdouh M
MM
The Department of Neurosurgery, Ain Shams University.
Ghorab
Ehab M
EM
Al-Abyad
Asharaf G
AG
Al-Bahy
Khaled M
KM
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage* / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D014750:Vincristine; D016190:Carboplatin