title: High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031).
abstract: OBJECTIVE
  To compare event-free survival (EFS) in children with high-risk medulloblastoma randomly assigned to receive either chemotherapy before radiation or chemotherapy after radiation.
  
  
  METHODS
  One hundred twelve patients were randomly assigned to each arm. Criteria used to categorize patients as high risk included M1-4 disease by modified Chang staging classification, T3b/T4 disease, or greater than 1.5 cm3 of residual tumor after surgery. Postoperatively, children with high-risk medulloblastoma were randomly assigned to two arms, either chemotherapy entailing three cycles of cisplatin and etoposide before radiation (chemotherapy first [CT1]) or the same chemotherapy regimen after radiation (radiation therapy first [RT1]). Both groups received consolidation chemotherapy consisting of vincristine and cyclophosphamide.
  
  
  RESULTS
  The median follow-up time was 6.4 years. Five-year EFS was 66.0% in the CT1 arm and 70.0% in the RT1 arm (P = .54), and 5-year overall survival in the two groups was 73.1% and 76.1%, respectively (P = .47). In the CT1 arm, 40 of the 62 patients with residual disease achieved either complete or partial remission.
  
  
  CONCLUSIONS
  Five-year EFS did not differ significantly whether, after surgery, patients received chemotherapy before or after radiotherapy.
authors.affiliation: Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. nancy_tarbell@hms.harvard.edu
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: Henry
authors.initials: H
authors.lastname: Friedman
authors.forename: William R
authors.initials: WR
authors.lastname: Polkinghorn
authors.forename: Torunn
authors.initials: T
authors.lastname: Yock
authors.forename: Tianni
authors.initials: T
authors.lastname: Zhou
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.forename: Peter
authors.initials: P
authors.lastname: Burger
authors.forename: Patrick
authors.initials: P
authors.lastname: Barnes
authors.forename: Larry
authors.initials: L
authors.lastname: Kun
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D059248:Chemoradiotherapy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin