title: Induction chemotherapy and conformal radiation therapy for very young children with nonmetastatic medulloblastoma: Children's Oncology Group study P9934.
abstract: OBJECTIVE
  P9934 was a prospective trial of systemic chemotherapy, second surgery, and conformal radiation therapy (CRT) limited to the posterior fossa and primary site for children between 8 months and 3 years old with nonmetastatic medulloblastoma. The study was open from June 2000 until June 2006.
  
  
  METHODS
  After initial surgery, children received four cycles of induction chemotherapy, followed by age- and response-adjusted CRT to the posterior fossa (18 or 23.4 Gy) and tumor bed (cumulative 50.4 or 54 Gy) and maintenance chemotherapy. Neurodevelopmental outcomes were evaluated and event-free survival (EFS) results were directly compared with a previous study of multiagent chemotherapy without irradiation (Pediatric Oncology Group [POG] trial 9233).
  
  
  RESULTS
  Seventy-four patients met eligibility requirements. The 4-year EFS and overall survival probabilities were 50% ± 6% and 69% ± 5.5%, respectively, which compared favorably to the results from POG 9233. Analysis showed that the desmoplastic/nodular subtype was a favorable factor in predicting survival. Our 4-year EFS rate was 58% ± 8% for patients with desmoplasia. Whereas seven of 10 patients who had disease progression before CRT had primary-site failure, 15 of 19 patients who progressed after CRT had distant-site failure. Neurodevelopmental assessments did not show a decline in cognitive or motor function after protocol-directed chemotherapy and CRT.
  
  
  CONCLUSIONS
  The addition of CRT to postoperative chemotherapy in young children with nonmetastatic medulloblastoma increased event-free survival compared with the use of postoperative chemotherapy alone. Future studies will use histopathologic typing (desmoplastic/nodular versus nondesmoplastic/nodular) to stratify patients for therapy by risk of relapse.
authors.affiliation: Deakin University, Geelong, Australia. dashle@barwonhealth.org.au
authors.forename: David M
authors.initials: DM
authors.lastname: Ashley
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Douglas
authors.initials: D
authors.lastname: Strother
authors.forename: Tianni
authors.initials: T
authors.lastname: Zhou
authors.forename: Patricia
authors.initials: P
authors.lastname: Duffner
authors.forename: Peter C
authors.initials: PC
authors.lastname: Burger
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Miller
authors.forename: Nancy
authors.initials: N
authors.lastname: Lyon
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Bonner
authors.forename: Michael
authors.initials: M
authors.lastname: Msall
authors.forename: Allen
authors.initials: A
authors.lastname: Buxton
authors.forename: Russell
authors.initials: R
authors.lastname: Geyer
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: Lee
authors.initials: L
authors.lastname: Coleman
authors.forename: Ian F
authors.initials: IF
authors.lastname: Pollack
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D020266:Radiotherapy, Conformal; D012086:Reoperation