title: Proposed strategy for the use of high-dose chemotherapy with stem cell rescue and intrathecal topotecan without whole-brain irradiation for infantile classic medulloblastoma.
abstract: We describe a 6-month-old infant with classic medulloblastoma. Gross total resection of the left cerebellar tumor was performed; however, relapse occurred during the administration of intrathecal and intravenous methotrexate-based chemotherapy. After undergoing resection, high-dose chemotherapy was administered consisting of topotecan, melphalan, and cyclophosphamide with autologous peripheral stem cell rescue followed by local irradiation and intrathecal topotecan, which resulted in a complete response for more than two years. The administration of high-dose chemotherapy followed by intrathecal topotecan as maintenance therapy is an effective strategy, without losses in the cognitive function, for avoiding the use of whole-brain irradiation for infantile classic medulloblastoma.
authors.affiliation: Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Yamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moritake
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Kamimura
authors.forename: Shinji
authors.initials: S
authors.lastname: Yamashita
authors.forename: Hideo
authors.initials: H
authors.lastname: Takeshima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nunoi
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002528:Cerebellar Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D008527:Medulloblastoma / Q000473:pathology / Q000628:therapy*; D008558:Melphalan / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D033581:Stem Cell Transplantation; D019772:Topotecan / Q000008:administration & dosage; D014182:Transplantation, Autologous
chemical_list: D019772:Topotecan; D003520:Cyclophosphamide; D008558:Melphalan
keywords: high-dose chemotherapy; histology; infantile medulloblastoma; intrathecal topotecan; stem cell transplantation