TY - JOUR
T1 - Results of a prospective randomized trial comparing standard dose neuraxis irradiation (3,600 cgy/20) with reduced neuraxis irradiation (2,340 cgy/13) in patients with low-stage medulloblastoma
AU - Deutsch, Melvin
AU - Thomas, Patrick R.M.
AU - Krischer, Jeffrey
AU - Boyett, James M.
AU - Albright, Leland
AU - Aronin, Patricia
AU - Langston, James
AU - Allen, Jeffrey C.
AU - Packer, Roger J.
AU - Linggood, Rita
AU - Mulhern, Raymond
AU - Stanley, Philip
AU - Stehbens, James A.
AU - Duffner, Patricia
AU - Kun, Larry
AU - Rorke, Lucy
AU - Cherlo, Joel
AU - Freidman, Harry
AU - Finlay, Jonathan L.
AU - Vietti, Teresa
PY - 1996/1/1
Y1 - 1996/1/1
N2 - Purpose:To determine in a prospective randomized trial the effect on survival, progression-free survival, and patterns of relapse of a decrease in the neuraxis radiation dose from 3,600 cGy in 20 fractions to 2,340 cGy in 13 fractions in patients with newly diagnosed medulloblastoma between 3 and 21 years of age with low T stage (T1T2and T3A), minimal postoperative residual tumor, and no evidence of dissemination (Mo).Methods and Materials:Between June 1986 and November 1990, the Children’s Cancer Group and the Pediatric Oncology Group randomized 126 patients in a two-arm study comparing the two different doses of neuraxis irradiation. In both arms, the posterior fossa received 5,400 cGy in 30 fractions. All patients were staged with myelography, postoperative lumbar cerebrospinal fluid cytology, and postoperative contrast-enhanced cranial computerized tomography to ensure no evidence of dissemination and no more than 1.5 cm3residual tumor volume. Overall survival, progression-free survival, and patterns of recurrence were carefully monitored. Prospective endocrine and psychometric studies were performed to determine the benefit of decreasing the neuraxis radiation dose.Results:Following an interim analysis at a median time on study of 16 months, the study was closed, since a statistically significant increase was observed in the number of all relapses as well as isolated neuraxis relapses in patients randomized to the lower dose of neuraxis radiation.Conclusions:In patients with newly diagnosed medulloblastoma considered to have a good prognosis on the basis of low T stage, minimal residual tumor after at least subtotal resection, and no evidence of dissemination after thorough evaluation, there is an increased risk of early relapse associated with lowering the dose of neuraxis radiation from 3,600 cGy in 20 fractions to 2,340 cGy in 13 fractions.
AB - Purpose:To determine in a prospective randomized trial the effect on survival, progression-free survival, and patterns of relapse of a decrease in the neuraxis radiation dose from 3,600 cGy in 20 fractions to 2,340 cGy in 13 fractions in patients with newly diagnosed medulloblastoma between 3 and 21 years of age with low T stage (T1T2and T3A), minimal postoperative residual tumor, and no evidence of dissemination (Mo).Methods and Materials:Between June 1986 and November 1990, the Children’s Cancer Group and the Pediatric Oncology Group randomized 126 patients in a two-arm study comparing the two different doses of neuraxis irradiation. In both arms, the posterior fossa received 5,400 cGy in 30 fractions. All patients were staged with myelography, postoperative lumbar cerebrospinal fluid cytology, and postoperative contrast-enhanced cranial computerized tomography to ensure no evidence of dissemination and no more than 1.5 cm3residual tumor volume. Overall survival, progression-free survival, and patterns of recurrence were carefully monitored. Prospective endocrine and psychometric studies were performed to determine the benefit of decreasing the neuraxis radiation dose.Results:Following an interim analysis at a median time on study of 16 months, the study was closed, since a statistically significant increase was observed in the number of all relapses as well as isolated neuraxis relapses in patients randomized to the lower dose of neuraxis radiation.Conclusions:In patients with newly diagnosed medulloblastoma considered to have a good prognosis on the basis of low T stage, minimal residual tumor after at least subtotal resection, and no evidence of dissemination after thorough evaluation, there is an increased risk of early relapse associated with lowering the dose of neuraxis radiation from 3,600 cGy in 20 fractions to 2,340 cGy in 13 fractions.
KW - Clinical trial
KW - Medulloblastoma
KW - Neuraxis irradiation
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U2 - 10.1159/000121042
DO - 10.1159/000121042
M3 - Article
C2 - 8873158
AN - SCOPUS:9344221694
SN - 1016-2291
VL - 24
SP - 167
EP - 177
JO - Pediatric Neurosurgery
JF - Pediatric Neurosurgery
IS - 4
ER -