The UK Experience of a Treatment Strategy for Pediatric Metastatic Medulloblastoma Comprising Intensive Induction Chemotherapy, Hyperfractionated Accelerated Radiotherapy and Response Directed High Dose Myeloablative Chemotherapy or Maintenance Chemothera

Abstract

Within the limits of statistical significance, we did not replicate the improved survival results reported in the original series. The reasons include differences in patient sub-groups and protocol administration. International randomized phase III studies are needed.

Impact of induction chemotherapy, hyperfractionated accelerated radiotherapy and high‐dose thiotepa on brain volume loss and functional status of children with primitive neuroectodermal tumour

“…As survival rates have increased, it has become clear that improvement has come at a price . Physical deficits, neuro‐psychological impairment and decreased quality of survival have been reported …”

“…4,11,12 As survival rates have increased, it has become clear that improvement has come at a price. 4,13 Physical deficits, neuro-psychological impairment and decreased quality of survival have been reported. [13][14][15] There is evidence that high-dose chemotherapy, combined with radiotherapy for childhood brain tumours, may result in a compound injury to the normal parenchyma of the developing brain.…”

“…4,13 Physical deficits, neuro-psychological impairment and decreased quality of survival have been reported. [13][14][15] There is evidence that high-dose chemotherapy, combined with radiotherapy for childhood brain tumours, may result in a compound injury to the normal parenchyma of the developing brain. 16 Parenchymal volume loss, generalised white matter signal changes and focal enhancing white matter lesions have recently been reported in children treated with a protocol which utilised high-dose sequential chemotherapy, hyperfractionated accelerated radiotherapy (HART) and myeloablative therapy with autologous stem cell rescue.…”

Comment on: The UK Experience of a Treatment Strategy for Pediatric Metastatic Medulloblastoma Comprising Intensive Induction Chemotherapy, Hyperfractionated Accelerated Radiotherapy, and Response Directed High‐Dose Myeloablative Chemotherapy or Maintenance Chemotherapy (Milan Strategy)

“…To the Editor: We read with both interest and concern the paper by Vivekanandan published in this journal . While the lower results for metastatic medulloblastoma compared to those originally reported by Gandola were already known, we were quite disappointed by some comments on our experience, and the lack of important, internationally recently shared aspects.…”

Reply to Comment on: The UK Experience of a Treatment Strategy for Pediatric Metastatic Medulloblastoma Comprising Intensive Induction Chemotherapy, Hyperfractionated Accelerated Radiotherapy, and Response‐Directed High‐Dose Myeloablative Chemotherapy or Maintenance Chemotherapy (Milan Strategy)

“…To the Editor: We thank Massimino and colleagues for their comments on our paper . Our study was a retrospective audit of survival, toxicity, and deliverability of this regimen in 14 UK centers.…”