title: Long-term results of combined preradiation chemotherapy and age-tailored radiotherapy doses for childhood medulloblastoma.
abstract: To reduce the sequelae of craniospinal irradiation (CSI) in children under 10 (≥3) years old and to improve the prognosis for high-risk medulloblastoma in adolescents, we adjusted postoperative chemotherapy and CSI doses to patients' stage and age. From 1986 to 1995, 73 patients entered the study. Children under 10 and adolescents with metastases, residual disease (RD) or stage >T3 received postoperative IV vincristine and high-dose (HD) ± intrathecal (IT) methotrexate, while standard-risk adolescents were given IV vincristine and IT methotrexate. Chemotherapy was followed by CSI (19.8 Gy for children <10; 36 Gy for adolescents), with a 54-Gy posterior fossa boost. Maintenance chemotherapy with lomustine and vincristine was administered for a year afterwards. A total of 39 children were under 10 of whom 20 had metastases. Response to chemotherapy was recorded in 70%, but 5-year EFS and OS were only 48 and 56%, respectively. Results were significantly worse for metastatic cases, patients under 10, those with RD, and those staged without MRI (unavailable early in the study). Efforts to preserve survivors' quality of life did not pay off, and most patients over 30 still depended on their parents' income and had severe cognitive/endocrine disabilities. In conclusion, despite a very high response rate with this preradiation HD methotrexate schedule, the outcome for high-risk medulloblastoma patients did not improve (especially when lower CSI doses were used) and patients still developed severe morbidities.
authors.affiliation: Pediatric Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Via Venezian, 1-20133, Milan, Italy. maura.massimino@istitutotumori.mi.it
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino
authors.forename: Graziella
authors.initials: G
authors.lastname: Cefalo
authors.forename: Daria
authors.initials: D
authors.lastname: Riva
authors.forename: Veronica
authors.initials: V
authors.lastname: Biassoni
authors.forename: Filippo
authors.initials: F
authors.lastname: Spreafico
authors.forename: Emilia
authors.initials: E
authors.lastname: Pecori
authors.forename: Geraldina
authors.initials: G
authors.lastname: Poggi
authors.forename: Paola
authors.initials: P
authors.lastname: Collini
authors.forename: Bianca
authors.initials: B
authors.lastname: Pollo
authors.forename: Laura
authors.initials: L
authors.lastname: Valentini
authors.forename: Paolo
authors.initials: P
authors.lastname: Potepan
authors.forename: Ettore
authors.initials: E
authors.lastname: Seregni
authors.forename: Michela
authors.initials: M
authors.lastname: Casanova
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Roberto
authors.initials: R
authors.lastname: Luksch
authors.forename: Daniela
authors.initials: D
authors.lastname: Polastri
authors.forename: Monica
authors.initials: M
authors.lastname: Terenziani
authors.forename: Federica
authors.initials: F
authors.lastname: Pallotti
authors.forename: Carlo Alfredo
authors.initials: CA
authors.lastname: Clerici
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Schiavello
authors.forename: Fabio
authors.initials: F
authors.lastname: Simonetti
authors.forename: Cristina
authors.initials: C
authors.lastname: Meazza
authors.forename: Serena
authors.initials: S
authors.lastname: Catania
authors.forename: Marta
authors.initials: M
authors.lastname: Podda
authors.forename: Lorenza
authors.initials: L
authors.lastname: Gandola
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D060046:Maintenance Chemotherapy / Q000379:methods*; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000532:radiotherapy*; D008727:Methotrexate / Q000627:therapeutic use; D009192:Myelography; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D009483:Neuropsychological Tests; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014750:Vincristine; D008727:Methotrexate