Long-term outcome and clinical prognostic factors in children with medulloblastoma treated in the prospective randomised multicentre trial HIT'91.
OBJECTIVE
To analyse long-term outcome and clinical prognostic factors in medulloblastoma.


METHODS
We analysed 280 patients with medulloblastoma (3-18 years) included from 1991 to 1997 in the randomised multicentre trial HIT'91 comparing pre-('sandwich') and postradiation ('maintenance') chemotherapy (median follow-up of survivors for 10 years).


RESULTS
In 187 patients with complete staging, overall survival (OS) was higher after maintenance compared to sandwich treatment for M0 (10-year OS 91% and 62%, p=0.001) and M1 patients (10-year OS 70% and 34%, p=0.020). In M2/3 disease, 10-year OS was 42% and 45%. Incomplete staging, metastases, younger age and sandwich chemotherapy were independent adverse risk factors. Twelve percent of all relapses (13 of 107) occurred after more than five years, and 12 patients had secondary neoplasms.


CONCLUSIONS
After maintenance therapy, long-term survival was excellent in fully assessable patients with localised medulloblastoma, and favourable for M1 patients. Patients should be followed longer for late relapses and secondary tumours.
Hoff
Katja von
KV
Department of Pediatrics, University of Wuerzburg, Germany.
Hinkes
Bernward
B
Department of Pediatrics, University of Wuerzburg, Germany.
Gerber
Nicolas U
NU
Department of Pediatrics, University of Wuerzburg, Germany.
Deinlein
Frank
F
Department of Pediatrics, University of Wuerzburg, Germany.
Mittler
Uwe
U
University Children's Hospital of Magdeburg, Germany.
Urban
Christian
C
Division of Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria.
Benesch
Martin
M
Division of Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria.
Warmuth-Metz
Monika
M
Department of Neuroradiology, University of Wuerzburg, Germany.
Soerensen
Niels
N
Department of Neurosurgery, ev. Hospital Oldenburg, Germany.
Zwiener
Isabella
I
Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany.
Goette
Heiko
H
Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany.
Schlegel
Paul G
PG
Department of Pediatrics, University of Wuerzburg, Germany.
Pietsch
Torsten
T
Department of Neuropathology, University of Bonn, Germany.
Kortmann
Rolf D
RD
Department of Radiation Oncology, University of Leipzig, Germany.
Kuehl
Joachim
J
Department of Pediatrics, University of Wuerzburg, Germany.
Rutkowski
Stefan
S
Department of Pediatrics, University of Wuerzburg, Germany; University Medical Center Hamburg-Eppendorf, Department of Pediatric Hematology and Oncology, Hamburg, Germany. Electronic address: rutkowski@uke.de.
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016609:Neoplasms, Second Primary; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D000970:Antineoplastic Agents; D014750:Vincristine