Treatment of children with medulloblastomas with reduced-dose craniospinalradiation therapy and adjuvant chemotherapy: A children's cancer group study

Purpose: Medulloblastomo is the most common malignant brain tumor of childh ood. After treatment with surgery and radiation therapy, approximately 60% of children with medulloblastoma are alive and free of progressive disease 5 years after diagnosis, bur many have significant neurocognitive sequelae. This study was undertaken to determine the feasibility and efficacy of tre ating children with nondisseminated medulloblastoma with reduced-dose crani ospinal radiotherapy plus adjuvant chemotherapy, Patients and Methods: Over a 3-year period, 65 children between 3 and 10 ye ars of age with nondisseminated medulloblastoma were treated with postopera tive, reduced-dose craniospinal radiation therapy (23.4 Oy) and 55.8 Gy of local radiation therapy. Adjuvant vincristine chemotherapy was administered during radiotherapy, and lomustine, vincristine, and cisplatin chemotherap y wets administered during and after radiation. Results: Progression-free survival was 86% +/- 4% at 3 years and 79% +/- 7% at 5 years. Sites of relapse for the 14 patients who developed progressive disease included the local tumor site alone in two patients, local tumor s ite and disseminated disease in nine, and nonprimary sites in three. Brains tem involvement did not adversely affect outcome. therapy was relatively we ll tolerated; however, the dose of cisplatin had to be modified in more tha n 50% of patients before the completion of treatment, One child died of pne umonitis and sepsis during treatment, Conclusion: These overall survival rates compare favorably to those obtaine d in studies using full-dose radiation therapy alone or radiation therapy p lus chemotherapy. The results suggest that reduced-dose craniospinal radiat ion therapy and adjuvant chemotherapy during and after radiation is a feasi ble approach for children with nondisseminated medulloblastoma. (C) 1999 by American Society of Clinical Oncology.