title: Treatment outcome and patterns of failure in patients of non-pineal supratentorial primitive neuroectodermal tumor: review of literature and clinical experience form a regional cancer center in north India.
abstract: BACKGROUND
  Supra-tentorial primitive neuroectodermal tumors (SPNET) are high-grade, hemispheric tumors, which account for around 2-3 % of pediatric brain tumors. We herein intend to report the clinical features and treatment outcome of patients with nonpineal SPNET treated at our institute.
  
  
  METHODS
  Clinical data were collected by retrospective chart review from 2006 to 2012. Histopathology slides were reviewed, and relevant immunohistochemistry stains were done. Overall survival (OS), recurrence-free survival (RFS) and event-free survival (EFS) were analyzed by the Kaplan-Meier product-limit method.
  
  
  RESULTS
  Fifteen patients met the study criterion (male: female = 2:1). Median age at presentation was 11 years (range 3-49 years). Surgical resection was gross total in 6 (40%) and subtotal in 8 (53.33%) patients. At presentation, two patients had leptomeningeal dissemination. Radiation therapy was delivered in 11 (73.33%) patients: craniospinal irradiation in 8 (36 Gy/20 fractions/4 weeks to the craniospinal axis followed by a local boost of 20 Gy/10 fractions/2 weeks) and focal RT in 3 patients. Systemic chemotherapy (median 6 cycles; range 1-16 cycles), given in 13 (86.67%) patients, included the VAC regimen (vincristine, adriamycin, cyclophosphamide) alternating with IE (ifosfamide,etoposide). After a median follow-up of 22.6 months (mean, 24.47 months), complete response and progressive disease were noted in 8 (53.33%) and 7 (46.67%) patients, respectively. Median OS was not reached, and estimated median EFS was noted to be 4.12 years (actuarial rate of EFS at 2 years, 55.2%).
  
  
  CONCLUSIONS
  Maximal safe resection followed by craniospinal irradiation and systemic chemotherapy with 6-12 cycles of an alternating regimen of VAC and IE is a reasonable treatment strategy in patients with nonpineal SPNET.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India, dr_ahitagni@yahoo.co.in.
authors.forename: Ahitagni
authors.initials: A
authors.lastname: Biswas
authors.forename: Supriya
authors.initials: S
authors.lastname: Mallick
authors.forename: Suvendu
authors.initials: S
authors.lastname: Purkait
authors.forename: Soumyajit
authors.initials: S
authors.lastname: Roy
authors.forename: Chitra
authors.initials: C
authors.lastname: Sarkar
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
authors.forename: Manmohan
authors.initials: M
authors.lastname: Singh
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Julka
authors.forename: Goura Kishor
authors.initials: GK
authors.lastname: Rath
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D018242:Neuroectodermal Tumors, Primitive / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D015173:Supratentorial Neoplasms / Q000628:therapy*; D055815:Young Adult