title: Postponed is not canceled: role of craniospinal radiation therapy in the management of recurrent infant medulloblastoma--an experience from the HIT-REZ 1997 & 2005 studies.
abstract: OBJECTIVE
  To evaluate the efficacy of craniospinal irradiation (CSI) in the management of recurrent infant medulloblastoma after surgery and chemotherapy alone.
  
  
  METHODS
  Seventeen pediatric medulloblastoma patients registered in the HIT-REZ 1997 and 2005 studies underwent CSI as salvage treatment at first recurrence. All patients had achieved complete remission after first-line treatment consisting of surgery and chemotherapy. Eleven patients showed metastatic disease at relapse. Five patients underwent surgery prior to radiation therapy, which resulted in complete resection in 1 case. In 1 patient, complete resection of the residual tumor was performed after CSI. Eleven patients received chemotherapy prior, 6 patients during and 8 patients after CSI. All patients received CSI with a median total dose of 35.2 Gy, and all but 1 received a boost to the posterior fossa (median total dose, 55.0 Gy). Metastases were boosted with an individual radiation dose, depending on their location and extent.
  
  
  RESULTS
  During a median follow-up time of 6.2 years since recurrence, 11 patients showed progressive disease and died. Median progression-free (overall) survival was 2.9 ± 1.1 (3.8 ± 0.8) years. Progression-free survival (PFS) rates at 1, 3, and 5 years were 88% ± 8%, 46% ± 12%, and 40% ± 12%, respectively. Overall survival (OS) rates at 1, 3, and 5 years were 94% ± 6%, 58% ± 12%, and 39% ± 12%, respectively. For 11 patients with classic medulloblastoma, 3-year (and 5-year) PFS and OS were 62% ± 15% and 72% ± 14% (52% ± 16% and 51% ± 16%), respectively. On univariate analysis, metastatic disease was not associated with poorer progression-free and overall survival.
  
  
  CONCLUSIONS
  Our results suggest that salvage treatment of relapsed medulloblastomas consisting of CSI and chemotherapy offers a second chance for cure, even for patients with classic histological findings. Metastatic disease at relapse did not have an impact on survival. However, this may be explained by the small number of patients.
authors.affiliation: Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany. Electronic address: Klaus.Mueller@medizin.uni-leipzig.de.
authors.forename: Klaus
authors.initials: K
authors.lastname: Müller
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Mynarek
authors.affiliation: Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz Medical Center, Mainz, Germany.
authors.forename: Isabella
authors.initials: I
authors.lastname: Zwiener
authors.affiliation: University Hospital of Essen, Pediatrics III, Essen, Germany.
authors.forename: Nele
authors.initials: N
authors.lastname: Siegler
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital, University Hospital of Bonn, Bonn, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: Department of Radiotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Christiansen
authors.affiliation: Clinic and Policlinic for Radiation Therapy and Radiooncology, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
authors.affiliation: Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Guido
authors.initials: G
authors.lastname: Henke
authors.affiliation: Department of Neuroradiology, University of Würzburg, Würzburg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Warmuth-Metz
authors.affiliation: Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Pietsch
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: von Hoff
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: von Bueren
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital, University Hospital of Bonn, Bonn, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Bode
authors.affiliation: Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rutkowski
authors.affiliation: Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany.
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Kortmann
authors.affiliation: University Hospital of Essen, Pediatrics III, Essen, Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Fleischhack
authors.affiliation: University Hospital of Essen, Pediatrics III, Essen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Tippelt
mesh_terms: D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016371:Cranial Irradiation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome