Low-Stage Medulloblastoma: Final Analysis of Trial Comparing Standard-Dose With Reduced-Dose Neuraxis Irradiation

Thomas, Patrick R.; Deutsch, Melvin; Kepner, James L.; Boyett, James M.; Krischer, Jeffrey; Aronin, Patricia A.; Albright, Leland; Allen, Jeffrey C.; Packer, Roger J.; Linggood, Rita M.; Mulhern, Raymond K.; Stehbens, James A.; Langston, J. William; Stanley, Philip; Duffner, Patricia K.; Rorke, Lucy B.; Cherlow, Joel M.; Friedman, Henry S.; Finlay, Jonathan L.; Vietti, Teresa J.; Kun, Larry E.

doi:10.1200/jco.2000.18.16.3004

Cited by 259 publications

(61 citation statements)

References 20 publications

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“…In children, there has been a growing interest in reducing the radiation dose to the craniospinal axis for patients with standard-risk disease. 28 The addition of chemotherapy may allow for a reduced craniospinal dose when treating children with standard-risk medulloblastoma. 12,13 It is not known whether this approach would work for adults as well.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes and Role of Chemotherapy in Adults With Newly Diagnosed Medulloblastoma

Call¹,

Naik²,

Rodríguez

et al. 2014

American Journal of Clinical Oncology

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Objective To assess the survival and role of adjuvant chemotherapy in adult medulloblastoma. Methods We reviewed outcomes of 66 patients (aged 18 y or more; median age, 33 y) with medulloblastoma. Forty-four (67%) patients had M0 disease, 9 had M1-M4, and 13 had MX. Thirty-one patients each for whom risk stratification was available were classified as high risk or standard risk. Fifty-six patients had histologic results: classic histology was the most common (n = 46 [84%]), followed by desmoplastic (n = 9), and large cell/anaplastic (n = 1). Overall survival (OS) and progression-free survival (PFS) were estimated with Kaplan-Meier curves and log-rank tests. Cox regression analysis was used to compare recurrences. Results Median follow-up was 6.7 years. The estimated 5-year OS and PFS were 74% and 59%, respectively. High-risk versus standard-risk classification was associated with worse OS (61% vs. 86%; P = 0.03) and recurrence (hazard ratio, 2.56; P = 0.05) and a trend for worse PFS (49% vs. 69%; P = 0.13). Gross total resection was associated with improved OS (P = 0.03) and a trend toward improved PFS (P = 0.09). No chemotherapy benefit could be demonstrated for the group as a whole. For high-risk patients with classic histology (n = 25), chemotherapy was associated with a trend for improvement in 5-year PFS from 36% to 71% (P = 0.10) and in 5-year OS from 49% to 100% (P = 0.08). Conclusions In adult patients with medulloblastoma, the extent of resection and risk classification predicts the outcome. These results suggest a chemotherapy benefit for high-risk patients with classic histology.

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Section: Discussionmentioning

confidence: 99%

Long-term Outcomes and Role of Chemotherapy in Adults With Newly Diagnosed Medulloblastoma

Call¹,

Naik²,

Rodríguez

et al. 2014

American Journal of Clinical Oncology

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“…A POG/CCG study showed reduced survival in children with standard risk medulloblastoma receiving reduced dose CSRT (23.4 Gy) as compared to those receiving standard dose CSRT (36 Gy) 41. Investigators in North America continued to explore the use of reduced dose CSRT, but with the administration of chemotherapy following radiotherapy.…”

Section: Standard/average Risk Medulloblastomamentioning

confidence: 99%

Medulloblastoma: new insights into biology and treatment

Pizer

Clifford

2008

Archives of Disease in Childhood - Education and Practice

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“…This is a reasonable assumption given the exceeding rarity of extracranial metastases [4]. Many extracranial metastases are in fact intraperitoneal in origin, and arise in the setting of shunts that divert CSF into this space.…”

Section: Discussionmentioning

confidence: 99%

“…Since we have not incorporated the effects of chemotherapy, a prescribed dose of 54 Gy to the brain and 36 Gy to the spine, administered at 1.8 Gy per day, has been used. This is the standard treatment regimen for a patient with medulloblastoma who is free from clinical evidence of disease outside the brain and negative CSF cytology [4]. Note that the model in its current formulation does not directly incorporate the effects of chemotherapy, which has emerged as a central component of therapy for patients with medulloblastoma.…”

Section: Methodsmentioning

confidence: 99%

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Kinetic modeling of tumor growth and dissemination in the craniospinal axis: implications for craniospinal irradiation

et al. 2006

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Background: Medulloblastoma and other types of tumors that gain access to the cerebrospinal fluid can spread throughout the craniospinal axis. The purpose of this study was to devise a simple multi-compartment kinetic model using established tumor cell growth and treatment sensitivity parameters to model the complications of this spread as well as the impact of treatment with craniospinal radiotherapy.

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Low-Stage Medulloblastoma: Final Analysis of Trial Comparing Standard-Dose With Reduced-Dose Neuraxis Irradiation

Cited by 259 publications

References 20 publications

Long-term Outcomes and Role of Chemotherapy in Adults With Newly Diagnosed Medulloblastoma

Long-term Outcomes and Role of Chemotherapy in Adults With Newly Diagnosed Medulloblastoma

Medulloblastoma: new insights into biology and treatment

Kinetic modeling of tumor growth and dissemination in the craniospinal axis: implications for craniospinal irradiation

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