title: Combination chemotherapy with ifosfamide, cisplatin, and etoposide for medulloblastoma: single-institute experience and differences in efficacy for subgroups of medulloblastoma.
abstract: OBJECTIVE
  Treatment for medulloblastoma consists of surgical resection, radiation therapy, and chemotherapy. In Japan, ICE chemotherapy consisting of cisplatin, ifosfamide, and etoposide is one of the most common regimens. Here, we summarize the toxicity and efficacy of ICE chemotherapy and evaluate the usefulness of the recently introduced molecular classification scheme to predict the outcome.
  
  
  METHODS
  Seventeen patients with medulloblastoma treated by ICE chemotherapy as an initial therapy at our institute were retrospectively reviewed. Eleven were categorized in the standard-risk group and six in the high-risk group. All patients underwent maximum cytoreductive surgery, radiation therapy, and ICE chemotherapy. Operative specimens were subjected to immunohistochemical staining using four antibodies-DKK1, SFRP1, NPR3, and KCNA1-to classify the cases into four subgroups, WNT group, SHH group, group C, and group D, respectively.
  
  
  RESULTS
  ICE chemotherapy following surgery and radiation therapy was tolerable in most patients with appropriate management, although myelosuppression and hearing disturbance occurred. There was no significant difference in survival between patients with standard-risk disease and high-risk disease. Five-year survival and 5-year progression-free survival for the 17 patients were 80.7% and 63.5%, respectively. Three patients were classified as WNT group, 2 as SHH group, 1 as group C, and 11 as group D. Group D tended to have poorer prognosis after ICE chemotherapy.
  
  
  CONCLUSIONS
  ICE chemotherapy was tolerable and active against medulloblastomas. Patients categorized as group D tended to have worse outcome after ICE chemotherapy.
authors: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan.
authors: Ryuta
authors: R
authors: Saito
authors: Toshihiro
authors: T
authors: Kumabe
authors: Yukihiko
authors: Y
authors: Sonoda
authors: Masayuki
authors: M
authors: Kanamori
authors: Yoji
authors: Y
authors: Yamashita
authors: Mika
authors: M
authors: Watanabe
authors: Teiji
authors: T
authors: Tominaga
references: J Clin Oncol. 2000 Aug;18(16):3004-11
references: 10944134
references: J Clin Oncol. 2011 Apr 10;29(11):1408-14
references: 20823417
references: J Clin Oncol. 1999 Jul;17(7):2127-36
references: 10561268
references: Neurol Med Chir (Tokyo). 1996 Sep;36(9):632-8
references: 8913079
references: Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):269-79
references: 10661332
references: Pediatr Neurosurg. 1996;24(4):167-176; discussion 176-7
references: 8873158
references: Arch Neurol. 2008 Nov;65(11):1419-24
references: 19001159
references: Neurosurgery. 1993 Nov;33(5):817-23
references: 8264878
references: J Clin Oncol. 2006 Sep 1;24(25):4202-8
references: 16943538
references: J Neurosurg. 2005 Jan;102(1 Suppl):44-52
references: 16206733
references: J Neurosurg. 1991 Mar;74(3):433-40
references: 1847194
references: Lancet Neurol. 2007 Dec;6(12):1073-85
references: 18031705