Impact of radiotherapy parameters on outcome in the International Society of Paediatric Oncology/United Kingdom Children's Cancer Study Group PNET-3 study of preradiotherapy chemotherapy for M0-M1 medulloblastoma

Taylor, Roger; Bailey, Chris; Robinson, K. L.; Weston, Claire; Ellison, David W.; Ironside, James W.; Lucraft, Helen; Gilbertson, Richard J.; Tait, Diana; Saran, Frank; Walker, David; Pizer, Barry; Lashford, L. S.

doi:10.1016/j.ijrobp.2003.08.010

Cited by 70 publications

(51 citation statements)

References 24 publications

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“…The trial documenting the efficacy of adjuvant CT was reported by CCG, combining the attenuated CSI dose in average risk patients that had shown only 55% EFS at 5 years in the POG-CCG trial referenced in the prior section with concurrent vincristine and post irradiation cisplatin, vincristine, and CCNU; the 79% PFS at 5 years confirmed earlier institutional experience to show among the best disease control rates then documented in this (124). The International Society for Pediatric Oncology (SIOP)-United Kingdom Children's Cancer Study Group (UKCCSG) PNET-3 trial showed improved EFS with limited pre irradiation CT and full-dose irradiation versus equivalent irradiation alone: 78% EFS at 5 years with pre irradiation vincristine, etoposide, carboplatin and cyclophosphamide compared to 65% with irradiation alone (118). A large randomized trial assessing reduced-dose CSI followed by cisplatin and vincristine with "standard" CCNU versus cyclophosphamide confirmed overall EFS more than 80% with no difference in disease control on either CT arm; early analysis suggests that a larger number of secondary neoplasm may be apparent in the cyclophosphamide arm (117).…”

Section: Chemotherapysupporting

confidence: 79%

“…The result is systematic reduction in CSI dosage to 23.4 Gy; with well documented efficacy now in average-risk disease when combined with contemporary cisplatin based CT (116,117). Agreement on combined chemo radiation is based on disease control rates that appear to be superior to those achieved with irradiation alone for both average-risk and high-risk presentations, a randomized European trial demonstrating improved outcome with chemo radiation compared to contemporary RT alone and several studies suggesting improvement in the risk: benefit ratio based on dose-volume modeling and evolving clinical data (118,119,120,121).…”

Section: Radiation Therapymentioning

confidence: 99%

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Malignant Brain Tumors in Childhood

Scarzello

Buzzaccarini

Sotti

2011

Management of CNS Tumors

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Section: Chemotherapysupporting

confidence: 79%

Section: Radiation Therapymentioning

confidence: 99%

Malignant Brain Tumors in Childhood

Scarzello

Buzzaccarini

Sotti

2011

Management of CNS Tumors

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“…In International Society of Paediatric Oncology (SIOP) PNET-3 study, it was stated that interruptions during treatment affected overall and disease-free survival adversely. [20] In their study involving adult patients with MB, Abacıoğlu et al reported the median duration of interval between surgery and RT as 31 days. Five year disease-free survival rates were found as 0% for patients who started their treatment earlier than 3 weeks, 85% for patients who started their treatment between 3 to 6 weeks, and 75% for patients who started their treatment after 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Surgery and Craniospinal Radiotherapy for Adult Patients with Medulloblastoma

Güzelöz¹

2017

TJ Oncol

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OBJECTIVEThe aim of the present study was to evaluate treatment outcomes for adult patients with medulloblastoma who received craniospinal irradiation following surgery at Dokuz Eylül University Radiation Oncology Department. METHODSTwelve patients were evaluated retrospectively. Median age was 31 years (range: 18-55 years). According to Chang staging system, 3 (25%) of the patients were T1, 2 (17%) were T2, 5 (42%) were T3, and 1 (8%) was T4; 1 patient could not be staged due to inadequate preoperative imaging. Tumor location, stage, presence of residual disease, duration between surgery and radiotherapy (RT), age, and sex were evaluated as prognostic factors. Statistical analyses were conducted using Kaplan-Meier method and SPSS for Windows, Version 15.0 (SPSS Inc., Chicago, IL, USA). RESULTSMedian dose was 36 Gy (range: 32-44 Gy) to craniospinal field and 54 Gy (range: 50-56 Gy) to primary tumor location. Median follow-up time was 62 months (range: 4-212 months). Five-, 10-, and 15-year overall survival rates were 79%, 63%, and 63%, and 5-, 10-and 15-year progression-free survival rates were 63%, 63%, and 63%, respectively. No statistically significant prognostic factor was found for survival rate. Three (25%) patients developed serious hematological toxicity during RT course. No grade 3 or 4 late side effect was observed. CONCLUSIONDespite the limited number of cases, results are consistent with the literature. Evaluation of features of this rare disease requires studies with larger number of.

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“…[4][5][6] Long-term survivors experience a spectrum of radiation-related treatment effects including hearing loss, 7 endocrine deficiencies, 8 somatic effects, 9 cognitive decline, 10 cerebrovascular damage 11,12 and secondary malignancies. 13 Measures have been taken to lessen the effects of radiation therapy for patients who have favorable outcomes including those with average-risk MB 14 defined as no evidence of neuraxis dissemination, a minimal amount of residual tumor and no evidence of brainstem invasion or transtentorial extension from the primary site.…”

Section: Introductionmentioning

confidence: 99%

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

Merchant¹,

Kun²,

Krasin³

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

152

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Purpose/Objective-Limiting neurocognitive sequelae of radiation therapy (RT) has been an objective in the treatment of medulloblastoma (MB). Conformal RT to less than the entire posterior fossa (PF) after craniospinal irradiation (CSI) may reduce neurocognitive sequelae and requires evaluation. October 1996 and August 2003, 86 patients, 3-21 years of age, with newly diagnosed, average-risk MB were treated on a prospective, IRB-approved, multi-institution trial of risk-adapted RT and dose-intensive chemotherapy. RT began within 28 days of definitive surgery and consisted of CSI (23.4 Gy), conformal PF RT (36.0 Gy) and primary site RT (55.8 Gy). The planning target volume for the primary site included the post-operative tumor bed surrounded by an anatomically confined margin of 2 cm which was then expanded with a geometric margin of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Materials/Methods-Between CONFLICT OF INTEREST NOTIFICATION:There are no conflicts of interest with the authors or materials in this manuscript. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript 0.3-0.5 cm. Chemotherapy was initiated 6 weeks after RT and included 4 cycles of high-dose cyclophosphamide, cisplatin and vincristine.Results-With a median follow-up of 61.2 months (5.2-115.0 months), the estimated 5-year eventfree survival and cumulative incidence of PF failure were 83.0% ± 5.3% and 4.9% ± 2.4% (±SE), respectively. Targeting guidelines used in this study resulted in a mean reduction of 13% in the volume of the PF receiving doses above 55Gy compared to conventionally planned RT. Reductions in dose to the temporal lobes, cochleae and hypothalamus were statistically significant.Conclusions-This prospective trial demonstrates that irradiation of less than the entire PF after 23.4 Gy CSI for average-risk MB results in disease control comparable to treatment of the entire PF.

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Impact of radiotherapy parameters on outcome in the International Society of Paediatric Oncology/United Kingdom Children's Cancer Study Group PNET-3 study of preradiotherapy chemotherapy for M0-M1 medulloblastoma

Cited by 70 publications

References 24 publications

Malignant Brain Tumors in Childhood

Malignant Brain Tumors in Childhood

Outcomes of Surgery and Craniospinal Radiotherapy for Adult Patients with Medulloblastoma

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

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