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

Melvin Deutsch, Patrick R.M. Thomas, Jeffrey Krischer, James M. Boyett, Leland Albright, Patricia Aronin, James Langston, Jeffrey C. Allen, Roger J. Packer, Rita Linggood, Raymond Mulhern, Philip Stanley, James A. Stehbens, Patricia Duffner, Larry Kun, Lucy Rorke, Joel Cherlo, Harry Freidman, Jonathan L. Finlay, Teresa Vietti

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)167-177
Number of pages11
JournalPediatric Neurosurgery
Volume24
Issue number4
DOIs
StatePublished - Jan 1 1996

Fingerprint

Medulloblastoma
Recurrence
Radiation
Residual Neoplasm
Disease-Free Survival
Myelography
Survival
Tumor Burden
Psychometrics
Cell Biology
Cerebrospinal Fluid
Tomography
Pediatrics
Neoplasms

Keywords

  • Clinical trial
  • Medulloblastoma
  • Neuraxis irradiation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology

Cite this

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. / Deutsch, Melvin; Thomas, Patrick R.M.; Krischer, Jeffrey; Boyett, James M.; Albright, Leland; Aronin, Patricia; Langston, James; Allen, Jeffrey C.; Packer, Roger J.; Linggood, Rita; Mulhern, Raymond; Stanley, Philip; Stehbens, James A.; Duffner, Patricia; Kun, Larry; Rorke, Lucy; Cherlo, Joel; Freidman, Harry; Finlay, Jonathan L.; Vietti, Teresa.

In: Pediatric Neurosurgery, Vol. 24, No. 4, 01.01.1996, p. 167-177.

Research output: Contribution to journalArticle

Deutsch, M, Thomas, PRM, Krischer, J, Boyett, JM, Albright, L, Aronin, P, Langston, J, Allen, JC, Packer, RJ, Linggood, R, Mulhern, R, Stanley, P, Stehbens, JA, Duffner, P, Kun, L, Rorke, L, Cherlo, J, Freidman, H, Finlay, JL & Vietti, T 1996, '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', Pediatric Neurosurgery, vol. 24, no. 4, pp. 167-177. https://doi.org/10.1159/000121042
Deutsch, Melvin ; Thomas, Patrick R.M. ; Krischer, Jeffrey ; Boyett, James M. ; Albright, Leland ; Aronin, Patricia ; Langston, James ; Allen, Jeffrey C. ; Packer, Roger J. ; Linggood, Rita ; Mulhern, Raymond ; Stanley, Philip ; Stehbens, James A. ; Duffner, Patricia ; Kun, Larry ; Rorke, Lucy ; Cherlo, Joel ; Freidman, Harry ; Finlay, Jonathan L. ; Vietti, Teresa. / 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. In: Pediatric Neurosurgery. 1996 ; Vol. 24, No. 4. pp. 167-177.
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abstract = "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.",
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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

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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.

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