TREATMENT OF STANDARD RISK MEDULLOBLASTOMA WITH CRANIOSPINAL IRRADIATION, CARBOPLATIN, AND VINCRISTINE

Background. Improved outcome for children with medulloblastoma require s new treatment protocols which incorporate chemotherapeutic agents th at are capable or eradicating minimal residual disease in the primary posterior fossa site and in the leptomeninges and whose toxicities are tolerable. Procedure. We treated 25 children with nondisseminated med ulloblastoma with complete or near complete surgical resection of the posterior fossa tumor, 3,600 cGy craniospinal irradiation (CSRT) and 5 ,400 cGy posterior fossa irradiation followed by adjuvant chemotherapy with carboplatin and vincristine. Results. The estimated 3-year progr ession-free survival (PFS) was 0.73 (S.E. +/- 0.09) compared with a 3- year PFS of 0.69 in historical controls treated with surgical resectio n and CSRT bur without chemotherapy. Six relapses occurred outside the posterior fossa and one relapse occurred both in the posterior fossa and in the lateral ventricle. The major acute toxicities were myelosup pression, anorexia and neuropathy. Conclusions. Our experience with th is adjuvant chemotherapy regimen with carboplatin and vincristine, as used by us, does not encourage its adoption in future clinical trials. (C) 1997 Wiley-Liss, Inc.