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Radiation improved survival in children with nonmetastatic medulloblastoma
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The addition of conformal radiation therapy to chemotherapy increased event-free survival in young children with nonmetastatic medulloblastoma, according to results of a prospective study.
The study, open from June 2000 to June 2006, involved 74 children aged 8 months to 3 years with nonmetastatic medulloblastoma. The researchers evaluated systemic chemotherapy, second surgery, and conformal radiation therapy limited to the posterior fossa and primary site for several outcome measures, including neurodevelopmental outcomes and event-free survival. These outcomes were compared with those from a previous study of multi-agent chemotherapy without irradiation (Pediatric Oncology Group trial 9233).
After initial surgery, children underwent four cycles of induction chemotherapy. Age- and response-adjusted conformal radiation therapy then were administered to the posterior fossa (18 Gy or 23.4 Gy) and tumor bed (cumulative 50.4 Gy or 54 Gy). Children then underwent maintenance chemotherapy.
The 4-year event-free survival probability was 50%. The OS probability at that time point was 69%. These results compared favorably with those from the previous study, the researchers said.
Desmoplastic/nodular subtype was a favorable prognostic factor for survival. Four-year event-free survival among patients with desmoplasia was 58%.
Primary-site failure occurred in seven of 10 patients whose disease progressed before radiation. Fifteen of the 19 patients with disease progression after radiation had distant-site failure.
During neurodevelopmental assessments, the researchers observed no decline in cognitive or motor function after protocol-directed chemotherapy and radiation.
“Future studies will use histopathologic typing (desmoplastic/nodular versus nondesmoplastic/nodular) to stratify patients for therapy by risk of relapse,” the researchers wrote.
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