TY - JOUR
T1 - Low-stage medulloblastoma
T2 - Final analysis of trial comparing standard-dose with reduced-dose neuraxis irradiation
AU - Thomas, Patrick R.M.
AU - Deutsch, Melvin
AU - Kepner, James L.
AU - Boyett, James M.
AU - Krischer, Jeffrey
AU - Aronin, Patricia
AU - Albright, Leland
AU - Allen, Jeffrey C.
AU - Packer, Roger J.
AU - Linggood, Rita
AU - Mulhern, Raymond
AU - Stehbens, James A.
AU - Langston, James
AU - Stanley, Philip
AU - Duffner, Patricia
AU - Rorke, Lucy
AU - Cherlow, Joel
AU - Friedman, Henry S.
AU - Finlay, Jonathan L.
AU - Vietti, Teresa J.
AU - Kun, Larry E.
PY - 2000
Y1 - 2000
N2 - Purpose: To evaluate prospectively the effects on survival, relapse-free survival, and patterns of relapse of reduced-dose (23.4 Gy in 13 fractions) compared with standard-dose (36 Gy in 20 fractions) neuraxis irradiation in patients 3 to 21 years of age with low-stage medulloblastoma, minimal postoperative residual disease, and no evidence of neuraxis disease. Patients and Methods: The Pediatric Oncology Group and Children's Cancer Group randomized 126 patients to the study. All patients received posterior fossa irradiation to a total dose of 54 Gy in addition to the neuraxis treatment. Patients were staged postoperatively with contrast-enhanced cranial computed to mography, myelography, and CSF cytology. Of the registered patients, 38 were ineligible. Results: The planned interim analysis that resulted in closure of the protocol showed that patients randomized to the reduced neuraxis treatment had increased frequency of relapse. In the final analysis, eligible patients receiving standard-dose neuroxis irradiation had 67% event-free survival (EFS) at 5 years (SE = 7.4%), whereas eligible patients receiving reduced-dose neuroxis irradiation had 52% event-free survival at 5 years (SE = 7.7%) (P = .080). At 8 years, the respective EFS proportions were also 67% (SE = 8.8%) and 52% (SE = 11%) (P = .141). These data confirm the original one-sided conclusions but suggest that differences are less marked with time. Conclusion: Reduced-dose neuroxis irradiation (23.4 Gy) is associated with increased risk of early relapse, early isolated neuraxis relapse, and lower 5-year EFS and overall survival than standard irradiation (36 Gy). The 5-year EFS for patients receiving standard-dose irradiation is suboptimal, and improved techniques and/or therapies are needed to improve ultimate outcome. Chemotherapy may contribute to this improvement. (C) 2000 by American Society of Clinical Oncology.
AB - Purpose: To evaluate prospectively the effects on survival, relapse-free survival, and patterns of relapse of reduced-dose (23.4 Gy in 13 fractions) compared with standard-dose (36 Gy in 20 fractions) neuraxis irradiation in patients 3 to 21 years of age with low-stage medulloblastoma, minimal postoperative residual disease, and no evidence of neuraxis disease. Patients and Methods: The Pediatric Oncology Group and Children's Cancer Group randomized 126 patients to the study. All patients received posterior fossa irradiation to a total dose of 54 Gy in addition to the neuraxis treatment. Patients were staged postoperatively with contrast-enhanced cranial computed to mography, myelography, and CSF cytology. Of the registered patients, 38 were ineligible. Results: The planned interim analysis that resulted in closure of the protocol showed that patients randomized to the reduced neuraxis treatment had increased frequency of relapse. In the final analysis, eligible patients receiving standard-dose neuroxis irradiation had 67% event-free survival (EFS) at 5 years (SE = 7.4%), whereas eligible patients receiving reduced-dose neuroxis irradiation had 52% event-free survival at 5 years (SE = 7.7%) (P = .080). At 8 years, the respective EFS proportions were also 67% (SE = 8.8%) and 52% (SE = 11%) (P = .141). These data confirm the original one-sided conclusions but suggest that differences are less marked with time. Conclusion: Reduced-dose neuroxis irradiation (23.4 Gy) is associated with increased risk of early relapse, early isolated neuraxis relapse, and lower 5-year EFS and overall survival than standard irradiation (36 Gy). The 5-year EFS for patients receiving standard-dose irradiation is suboptimal, and improved techniques and/or therapies are needed to improve ultimate outcome. Chemotherapy may contribute to this improvement. (C) 2000 by American Society of Clinical Oncology.
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U2 - 10.1200/JCO.2000.18.16.3004
DO - 10.1200/JCO.2000.18.16.3004
M3 - Article
C2 - 10944134
AN - SCOPUS:0033902778
SN - 0732-183X
VL - 18
SP - 3004
EP - 3011
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 16
ER -