title: Preradiation Chemotherapy for Adult High-risk Medulloblastoma: A Trial of the ECOG-ACRIN Cancer Research Group (E4397).
abstract: To assess the long-term outcomes and objective response (OR) to preradiation chemotherapy and radiation in adult high-risk medulloblastoma.
  
  
  
  In this prospective phase II trial, adults with high-risk medulloblastoma were treated with 3 cycles of preradiation cisplatin, etoposide, cyclophosphamide, and vincristine followed by craniospinal radiation (CSI). OR, progression-free survival (PFS), overall survival (OS), and toxicities were assessed.
  
  
  
  Eleven patients were enrolled over a 6-year period. Six (55%) had subarachnoid metastases. Two (18%) had an OR to preradiation chemotherapy. Two (18%) progressed while on chemotherapy. Completion of CSI was not compromised. The OR rate after chemotherapy and radiation was 45% (5/11). Nonevaluable patients at both time-points weakened the response data conclusions. Median PFS was 43.8 months. Five-year PFS was 27%. Five-year OS was 55%. Nonmetastatic (M0) and metastatic (M+) patients had similar outcomes.
  
  
  
  The OR to this preradiation chemotherapy regimen is lower than anticipated from the adult and pediatric literature raising a question about comparative efficacy of chemotherapy in different age groups. The OS achieved is similar to retrospective adult series, but worse than pediatric outcomes. Although this regimen can be administered without compromising delivery of CSI, our results do not provide support for the use of this neoadjuvant chemotherapy for adult medulloblastoma.
authors.affiliation: Vanderbilt University and TVHS, Nashville, TN.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Moots
authors.affiliation: Dana Farber Cancer Institute, Boston, MA.
authors.forename: Anne
authors.initials: A
authors.lastname: O'Neill
authors.affiliation: Humphrey Cancer Center, Robbinsdale, MN.
authors.forename: Harold
authors.initials: H
authors.lastname: Londer
authors.affiliation: Department of Human Oncology, University of Wisconsin, Madison, WI.
authors.forename: Minesh
authors.initials: M
authors.lastname: Mehta
authors.affiliation: Division of Oncology, University of Utah, Salt Lake City, UT.
authors.forename: Deborah T
authors.initials: DT
authors.lastname: Blumenthal
authors.affiliation: Department of Neurology, Wayne State University, Detroit, MI.
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Barger
authors.affiliation: University of Connecticut Health Center, Farmington, CT.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Grunnet
authors.affiliation: Johns Hopkins University Medical Center, Baltimore, MD.
authors.forename: Stuart
authors.initials: S
authors.lastname: Grossman
authors.affiliation: M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Gilbert
authors.affiliation: University of Virginia Medical Center, Charlottesville, VA.
authors.forename: David
authors.initials: D
authors.lastname: Schiff
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D059248:Chemoradiotherapy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult