Treatment of early childhood medulloblastoma by postoperative chemotherapy and deferred radiotherapy
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Treatment of early childhood medulloblastoma by postoperative chemotherapy and deferred radiotherapy. / Rutkowski, Stefan; Gerber, Nicolas Ulrich; von Hoff, Katja; Gnekow, Astrid; Bode, Udo; Graf, Norbert; Berthold, Frank; Henze, Günter; Wolff, Johannes E A; Warmuth-Metz, Monika; Soerensen, Niels; Emser, Angela; Ottensmeier, Holger; Deinlein, Frank; Schlegel, Paul-Gerhardt; Kortmann, Rolf-Dieter; Pietsch, Torsten; Kuehl, Joachim; German Pediatric Brain Tumor Study Group.
in: NEURO-ONCOLOGY, Jahrgang 11, Nr. 2, 04.2009, S. 201-10.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Treatment of early childhood medulloblastoma by postoperative chemotherapy and deferred radiotherapy
AU - Rutkowski, Stefan
AU - Gerber, Nicolas Ulrich
AU - von Hoff, Katja
AU - Gnekow, Astrid
AU - Bode, Udo
AU - Graf, Norbert
AU - Berthold, Frank
AU - Henze, Günter
AU - Wolff, Johannes E A
AU - Warmuth-Metz, Monika
AU - Soerensen, Niels
AU - Emser, Angela
AU - Ottensmeier, Holger
AU - Deinlein, Frank
AU - Schlegel, Paul-Gerhardt
AU - Kortmann, Rolf-Dieter
AU - Pietsch, Torsten
AU - Kuehl, Joachim
AU - German Pediatric Brain Tumor Study Group
PY - 2009/4
Y1 - 2009/4
N2 - To investigate the utility of postoperative chemotherapy in delaying radiotherapy and to identify prognostic factors in early childhood medulloblastoma, we studied children younger than 3 years of age registered to the HIT-SKK'87 (Therapieprotokoll für Säuglinge und Kleinkinder mit Hirntumoren [Brain Tumor Radiotherapy for Infants and Toddlers with Medulloblastoma] 1987) trial who received systemic interval chemotherapy until craniospinal radiotherapy was applied at 3 years of age or at relapse, from 1987 to 1993. Children with postoperative residual tumor or metastatic disease received systemic induction chemotherapy prior to interval chemotherapy. Twenty-nine children were eligible for analyses (median age, 1.7 years; median follow-up, 12.6 years). In children without macroscopic metastases, rates (+/-SEM) for 10-year progression-free survival (PFS) and overall survival (OS) were 52.9% +/- 12.1% and 58.8% +/- 11.9% (complete resection), and 55.6% +/- 16.6% and 66.7% +/- 15.7% (incomplete resection), compared with 0% and 0% in children with macroscopic metastases. Survival was superior in nine children with desmoplastic or extensive nodular histology compared with 20 children with classic medulloblastoma (10-year PFS, 88.9% +/- 10.5% and 30.0% +/- 10.3%, p = 0.003; OS, 88.9% +/- 10.5% and 40.0% +/- 11.0%, p = 0.006). Eleven of 12 children with tumor progression during chemotherapy had classic medulloblastoma. After treatment, IQ scores were inferior compared with nonirradiated children from the subsequent study, HIT-SKK'92. Classic histology, metastatic disease, and male gender were independent adverse risk factors for PFS and OS in 72 children from HIT-SKK'87 and HIT-SKK'92 combined. In terms of survival, craniospinal radiotherapy was successfully delayed especially in young children with medulloblastoma of desmoplastic/extensive nodular histology, which was a strong independent favorable prognostic factor. Because of the neurocognitive deficits of survivors, the emerging concepts to avoid craniospinal radiotherapy should rely on the histological medulloblastoma subtype.
AB - To investigate the utility of postoperative chemotherapy in delaying radiotherapy and to identify prognostic factors in early childhood medulloblastoma, we studied children younger than 3 years of age registered to the HIT-SKK'87 (Therapieprotokoll für Säuglinge und Kleinkinder mit Hirntumoren [Brain Tumor Radiotherapy for Infants and Toddlers with Medulloblastoma] 1987) trial who received systemic interval chemotherapy until craniospinal radiotherapy was applied at 3 years of age or at relapse, from 1987 to 1993. Children with postoperative residual tumor or metastatic disease received systemic induction chemotherapy prior to interval chemotherapy. Twenty-nine children were eligible for analyses (median age, 1.7 years; median follow-up, 12.6 years). In children without macroscopic metastases, rates (+/-SEM) for 10-year progression-free survival (PFS) and overall survival (OS) were 52.9% +/- 12.1% and 58.8% +/- 11.9% (complete resection), and 55.6% +/- 16.6% and 66.7% +/- 15.7% (incomplete resection), compared with 0% and 0% in children with macroscopic metastases. Survival was superior in nine children with desmoplastic or extensive nodular histology compared with 20 children with classic medulloblastoma (10-year PFS, 88.9% +/- 10.5% and 30.0% +/- 10.3%, p = 0.003; OS, 88.9% +/- 10.5% and 40.0% +/- 11.0%, p = 0.006). Eleven of 12 children with tumor progression during chemotherapy had classic medulloblastoma. After treatment, IQ scores were inferior compared with nonirradiated children from the subsequent study, HIT-SKK'92. Classic histology, metastatic disease, and male gender were independent adverse risk factors for PFS and OS in 72 children from HIT-SKK'87 and HIT-SKK'92 combined. In terms of survival, craniospinal radiotherapy was successfully delayed especially in young children with medulloblastoma of desmoplastic/extensive nodular histology, which was a strong independent favorable prognostic factor. Because of the neurocognitive deficits of survivors, the emerging concepts to avoid craniospinal radiotherapy should rely on the histological medulloblastoma subtype.
KW - Antineoplastic Agents
KW - Cerebellar Neoplasms
KW - Child, Preschool
KW - Combined Modality Therapy
KW - Cranial Irradiation
KW - Disease-Free Survival
KW - Female
KW - Humans
KW - Infant
KW - Male
KW - Medulloblastoma
KW - Neoplasm Recurrence, Local
KW - Pilot Projects
KW - Prognosis
KW - Survival Rate
KW - Treatment Outcome
U2 - 10.1215/15228517-2008-084
DO - 10.1215/15228517-2008-084
M3 - SCORING: Journal article
C2 - 18818397
VL - 11
SP - 201
EP - 210
JO - NEURO-ONCOLOGY
JF - NEURO-ONCOLOGY
SN - 1522-8517
IS - 2
ER -
