Adding Radiation Aids Pediatric Nonmetastatic Medulloblastoma

Induction chemotherapy plus conformal radiation therapy improves event-free survival

WEDNESDAY, Aug. 1 (HealthDay News) -- Compared with postoperative chemotherapy alone, adding conformal radiation therapy (CRT) to induction chemotherapy for the treatment of young children with nonmetastatic medulloblastoma increases event-free survival (EFS), according to a study published online July 30 in the Journal of Clinical Oncology.

David M. Ashley, M.B.B.S., Ph.D., of Deakin University in Geelong, Australia, and colleagues conducted a study involving 74 children between the ages of 8 months and 2 years with nonmetastatic medulloblastoma who first received surgery, followed by four cycles of induction chemotherapy, and then were treated with CRT to the posterior fossa and tumor bed and maintenance chemotherapy. Results were compared with those of a previously conducted study which included chemotherapy without radiation (Pediatric Oncology Group [POG] trial 9233).

The researchers found that the four-year overall survival was 69 percent, and the EFS was 50 percent, which compared favorably with POG 9233. Children who had the desmoplastic/nodular subtype had more favorable survival than those with other subtypes, with four-year EFS of 58 percent for those with desmoplasia. Primary site failure occurred in seven of 10 patients who had disease progression before CRT, while distant-site failure occurred in 15 of 19 who progressed after CRT. No decline in motor or cognitive function was noted after induction chemotherapy and CRT.

"The addition of CRT to postoperative chemotherapy in young children with nonmetastatic medulloblastoma increased event-free survival compared with the use of postoperative chemotherapy alone," the authors write. "Future studies will use histopathologic typing (desmoplastic/nodular versus nondesmoplastic/nodular) to stratify patients for therapy by risk of relapse."

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