A multi-institution prospective trial of reduced-dose craniospinal irradiation (23.4 Gy) followed by conformal posterior fossa (36 Gy) and primary site irradiation (55.8 Gy) and dose-intensive chemotherapy for average-risk medulloblastoma

Merchant, T.E.; Kun, L.; Krasin, Matthew J.; Jones-Wallace, Dana; Chintagumpala, Murali; Woo, S. L. C.; Ashley, David L.; Sexton, M; Kellie, Stewart J.; Ahern, V; Gajjar, Amar

doi:10.1016/s0360-3016(03)00994-5

Cited by 31 publications

(36 citation statements)

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“…Additionally, many patients in these studies did not receive regimens containing cisplatin, an agent that is currently used commonly and is associated with improved disease control in pediatric MB. 2,3,19 Due to the lack of high-quality evidence and potential differences in risks and benefits of adjuvant therapies in children and adults, there may be disagreement on the use of adjuvant chemotherapy for adult MB. While CSI is associated with side effects in all patients, children are particularly prone to long-term and deleterious morbidity from CSI.…”

Section: Neurooncologymentioning

confidence: 99%

“…2,3 Adoption of adjuvant chemotherapy in the pediatric setting has been associated with improved disease control and has allowed successful CSI dose deescalation in average-risk patients. [2][3][4][5] Even though chemotherapy is used routinely for pediatric patients, its benefit in adult MB is unclear. Data supporting adjuvant chemotherapy in the adult MB population are scarce.…”

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confidence: 99%

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Adjuvant chemotherapy and overall survival in adult medulloblastoma

Kann¹,

Lester-Coll²,

Park³

et al. 2016

Neuro Oncol

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Medulloblastoma (MB) is the most common brain tumor in children. However, it is relatively rare in adults, with an estimated incidence of 0.6 per million. 1 The standardof-care management for pediatric MB is postoperative radiotherapy (RT) with craniospinal irradiation (CSI) and posterior fossa or resection bed boost followed by adjuvant chemotherapy. 2,3 Adoption of adjuvant chemotherapy in the pediatric setting has been associated with improved disease control and has allowed successful CSI dose deescalation in average-risk patients. [2][3][4][5] Even though chemotherapy is used routinely for pediatric patients, its benefit in adult MB is unclear. Data supporting adjuvant chemotherapy in the adult MB population are scarce. There are no randomized trials investigating the benefit of chemotherapy in adult MB, and evidence is generally limited to small retrospective series reported over several decades with conflicting results. [6][7][8][9] Furthermore, compared with children, adults may suffer less toxicity from CSI and greater morbidity from chemotherapy. This may lead to hesitancy in using postoperative chemotherapy, Adjuvant chemotherapy and overall survival in adult medulloblastoma AbstractBackground. Although chemotherapy is used routinely in pediatric medulloblastoma (MB) patients, its benefit for adult MB is unclear. We evaluated the survival impact of adjuvant chemotherapy in adult MB. Methods. Using the National Cancer Data Base, we identified patients aged 18 years and older who were diagnosed with MB in 2004-2012 and underwent surgical resection and adjuvant craniospinal irradiation (CSI). Patients were divided into those who received adjuvant CSI and chemotherapy (CRT) or CSI alone (RT). Predictors of CRT compared with RT were evaluated with univariable and multivariable logistic regression. Survival analysis was limited to patients receiving CSI doses between 23 and 36 Gy. Overall survival (OS) was evaluated using the Kaplan-Meier estimator, log-rank test, multivariable Cox proportional hazards modeling, and propensity score matching. Results. Of the 751 patients included, 520 (69.2%) received CRT, and 231 (30.8%) received RT. With median followup of 5.0 years, estimated 5-year OS was superior in patients receiving CRT versus RT (86.1% vs 71.6%, P < .0001). On multivariable analysis, after controlling for risk factors, CRT was associated with superior OS compared with RT (HR: 0.53; 95%CI: 0.32-0.88, P = .01). On planned subgroup analyses, the 5 year OS of patients receiving CRT versus RT was improved for M0 patients (P < .0001), for patients receiving 36 Gy CSI (P = .0007), and for M0 patients receiving 36 Gy CSI (P = .0008). Conclusions. This national database analysis demonstrates that combined postoperative chemotherapy and radiotherapy are associated with superior survival for adult MB compared with radiotherapy alone, even for M0 patients who receive high-dose CSI.

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Section: Neurooncologymentioning

confidence: 99%

mentioning

confidence: 99%

Adjuvant chemotherapy and overall survival in adult medulloblastoma

Kann¹,

Lester-Coll²,

Park³

et al. 2016

Neuro Oncol

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“…A multi-institutional prospective trial using 23.4 Gy craniospinal irradiation followed by conformal posterior fossa (36 Gy) and primary site irradiation (55.8 Gy), and dose-intensive chemotherapy for average risk medulloblastoma achieved similar disease control than irradiation of the complete posterior fossa. 22 Other investigators used a boost dose to the tumor bed, instead of irradiating the entire posterior fossa using conformal radiation therapy with 5-year overall survival (OS) rates of 84%. 23 Proton beam therapy is another alternative to conventional radiation therapy.…”

Section: Radiationmentioning

confidence: 99%

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

2009

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Summary:Pediatric CNS tumors are the most common solid tumors of childhood and the second most common cancer after hematological malignancies accounting for approximate 20 to 25% of all primary pediatric tumors. With over 3,000 new cases per year in the United States, childhood CNS tumors are the leading cause of death related to cancer in this population. The prognosis for these patients has improved over the last few decades, but current therapies continue to carry a high risk of significant side effects, especially for the very young. Currently a combination of surgery, radiation, and chemotherapy is often used in children greater than 3 years of age. This article will outline current and future therapeutic strategies for the most common pediatric CNS tumors, including primitive neuroectodermal tumors such as medulloblastoma, as well as astrocytomas and ependymomas.

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“…Six weeks later, 86 patients with average risk MB received four cycles of chemotherapy including VCR, cyclophosphamide and cisplatin. They achieved similar disease control as previous regimens and 13% reduction in volume radiated in the PF [42]. Evidence level A…”

Section: Will Adjuvant or Neoadjuvant Chemotherapy Improve Survival?mentioning

confidence: 62%

Evidence in medulloblastomas

Navajas

Giralt

2010

Clin Transl Oncol

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Medulloblastoma is the most common infratentorial malignant tumour under 15 years of age. In recent protocols, the patients are stratified for treatment in standard risk or high risk, according to the clinical variables as age, localized or disseminated disease, degree of surgical resection and more recently expected biological behaviour based on retrospective and prospective studies of former samples analyzed. The objectives for future treatments are reduce morbidity without jeopardizing survival.

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A multi-institution prospective trial of reduced-dose craniospinal irradiation (23.4 Gy) followed by conformal posterior fossa (36 Gy) and primary site irradiation (55.8 Gy) and dose-intensive chemotherapy for average-risk medulloblastoma

Cited by 31 publications

References 0 publications

Adjuvant chemotherapy and overall survival in adult medulloblastoma

Adjuvant chemotherapy and overall survival in adult medulloblastoma

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

Evidence in medulloblastomas

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