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Reduced-dose craniospinal radiotherapy followed by high-dose chemotherapy and autologous stem cell rescue for children with newly diagnosed high-risk medulloblastoma or supratentorial primitive neuroectodermal tumor.

Kim SY, Sung KW, Hah JO, Yoo KH, Koo HH, Kang HJ, Park KD, Shin HY, Ahn HS, Im HJ, Seo JJ, Lim YJ, Lee YH, Shin HJ, Lim do H, Cho BK, Ra YS, Choi JU - Korean J Hematol (2010)

Bottom Line: No treatment-related mortality occurred during HDCT.Although the follow-up period was short and the patient cohort was small in size, the results of this study are encouraging.The limited toxicity and favorable EFS rate observed in children treated with reduced-dose CSRT followed by HDCT and ASCR warrant further exploration in a larger study population.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea.

ABSTRACT

Background: In this study, we investigated the effects of reduced-dose craniospinal radiotherapy (CSRT) followed by tandem high-dose chemotherapy (HDCT) with autologous stem cell rescue (ASCR) in children with a newly diagnosed high-risk medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (sPNET).

Methods: Between March 2005 and April 2007, patients older than 3 years with a newly diagnosed high-risk MB or sPNET were enrolled. The patients received two cycles of pre-RT chemotherapy consisting of cisplatin, etoposide, vincristine, and cyclophosphamide (cycle A), and carboplatin, etoposide, vincristine, and ifosphamide (cycle B), followed by CSRT with 23.4 Gy and local RT with 30.6 Gy. After four cycles of post-RT chemotherapy (cycles A, B, A, and B), tandem double HDCT with ASCR was performed.

Results: A total of 13 patients (MB=11, sPNET=2) were enrolled. Of these, one patient progressed, one patient died of septic shock after the second cycle of B, and one patient relapsed after the third cycle of B. The 3-year event-free survival (EFS) rate of the patients intended for HDCT was 76.9%, whereas the 3-year EFS rate of the patients who received HDCT was 100%. No treatment-related mortality occurred during HDCT.

Conclusion: Although the follow-up period was short and the patient cohort was small in size, the results of this study are encouraging. The limited toxicity and favorable EFS rate observed in children treated with reduced-dose CSRT followed by HDCT and ASCR warrant further exploration in a larger study population.

No MeSH data available.


Related in: MedlinePlus

(A) The probability of 3-year overall survival (a) and event-free survival (EFS) (b) for the 13 patients were 84.6±10.0% and 76.9±11.7%, respectively. (B) The probability of 3-year EFS for the Mo (a) and M+ patients (b) was 100 and 70.0±14.5%, respectively. (C) The EFS for medulloblastoma patients with M0 (a) was 100%, whereas that for patients with M+ (b) at diagnosis was 77.8±13.9%.
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Figure 2: (A) The probability of 3-year overall survival (a) and event-free survival (EFS) (b) for the 13 patients were 84.6±10.0% and 76.9±11.7%, respectively. (B) The probability of 3-year EFS for the Mo (a) and M+ patients (b) was 100 and 70.0±14.5%, respectively. (C) The EFS for medulloblastoma patients with M0 (a) was 100%, whereas that for patients with M+ (b) at diagnosis was 77.8±13.9%.

Mentions: The median follow-up duration was 39 months (range 6-50). The probability of 3-year EFS for the 13 patients was 76.9±11.7%, whereas the 3-year OS was 84.6±10.0% (Fig. 2A). The 3-year EFS rate for those patients who actually received HDCT was 100%. The 3-year EFS rate for the Mo patients was 100%, whereas the rate for the M+ patients was 70.0±14.5% (Fig. 2B). One of the 11 patients was diagnosed with a MB relapsed, and another had PD prior to HDCT; hence, the 2-year EFS of the MB patients was 81.8±11.6%. Among the 9 patients with MB who received HDCT, 8 received tandem double HDCT with ASCR, and none exhibited a relapse or TRM. The 3-year EFS rate for the M0 patients with MB was 100%, whereas the rate for the M+ patients at the time of diagnosis was 77.8±13.9% (Fig. 2C). One of the 2 sPNET patients received HDCT1; however, no further treatment was given based on the wishes of the parents, and another patient died of sepsis after chemotherapy cycle B2.


Reduced-dose craniospinal radiotherapy followed by high-dose chemotherapy and autologous stem cell rescue for children with newly diagnosed high-risk medulloblastoma or supratentorial primitive neuroectodermal tumor.

Kim SY, Sung KW, Hah JO, Yoo KH, Koo HH, Kang HJ, Park KD, Shin HY, Ahn HS, Im HJ, Seo JJ, Lim YJ, Lee YH, Shin HJ, Lim do H, Cho BK, Ra YS, Choi JU - Korean J Hematol (2010)

(A) The probability of 3-year overall survival (a) and event-free survival (EFS) (b) for the 13 patients were 84.6±10.0% and 76.9±11.7%, respectively. (B) The probability of 3-year EFS for the Mo (a) and M+ patients (b) was 100 and 70.0±14.5%, respectively. (C) The EFS for medulloblastoma patients with M0 (a) was 100%, whereas that for patients with M+ (b) at diagnosis was 77.8±13.9%.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2983022&req=5

Figure 2: (A) The probability of 3-year overall survival (a) and event-free survival (EFS) (b) for the 13 patients were 84.6±10.0% and 76.9±11.7%, respectively. (B) The probability of 3-year EFS for the Mo (a) and M+ patients (b) was 100 and 70.0±14.5%, respectively. (C) The EFS for medulloblastoma patients with M0 (a) was 100%, whereas that for patients with M+ (b) at diagnosis was 77.8±13.9%.
Mentions: The median follow-up duration was 39 months (range 6-50). The probability of 3-year EFS for the 13 patients was 76.9±11.7%, whereas the 3-year OS was 84.6±10.0% (Fig. 2A). The 3-year EFS rate for those patients who actually received HDCT was 100%. The 3-year EFS rate for the Mo patients was 100%, whereas the rate for the M+ patients was 70.0±14.5% (Fig. 2B). One of the 11 patients was diagnosed with a MB relapsed, and another had PD prior to HDCT; hence, the 2-year EFS of the MB patients was 81.8±11.6%. Among the 9 patients with MB who received HDCT, 8 received tandem double HDCT with ASCR, and none exhibited a relapse or TRM. The 3-year EFS rate for the M0 patients with MB was 100%, whereas the rate for the M+ patients at the time of diagnosis was 77.8±13.9% (Fig. 2C). One of the 2 sPNET patients received HDCT1; however, no further treatment was given based on the wishes of the parents, and another patient died of sepsis after chemotherapy cycle B2.

Bottom Line: No treatment-related mortality occurred during HDCT.Although the follow-up period was short and the patient cohort was small in size, the results of this study are encouraging.The limited toxicity and favorable EFS rate observed in children treated with reduced-dose CSRT followed by HDCT and ASCR warrant further exploration in a larger study population.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea.

ABSTRACT

Background: In this study, we investigated the effects of reduced-dose craniospinal radiotherapy (CSRT) followed by tandem high-dose chemotherapy (HDCT) with autologous stem cell rescue (ASCR) in children with a newly diagnosed high-risk medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (sPNET).

Methods: Between March 2005 and April 2007, patients older than 3 years with a newly diagnosed high-risk MB or sPNET were enrolled. The patients received two cycles of pre-RT chemotherapy consisting of cisplatin, etoposide, vincristine, and cyclophosphamide (cycle A), and carboplatin, etoposide, vincristine, and ifosphamide (cycle B), followed by CSRT with 23.4 Gy and local RT with 30.6 Gy. After four cycles of post-RT chemotherapy (cycles A, B, A, and B), tandem double HDCT with ASCR was performed.

Results: A total of 13 patients (MB=11, sPNET=2) were enrolled. Of these, one patient progressed, one patient died of septic shock after the second cycle of B, and one patient relapsed after the third cycle of B. The 3-year event-free survival (EFS) rate of the patients intended for HDCT was 76.9%, whereas the 3-year EFS rate of the patients who received HDCT was 100%. No treatment-related mortality occurred during HDCT.

Conclusion: Although the follow-up period was short and the patient cohort was small in size, the results of this study are encouraging. The limited toxicity and favorable EFS rate observed in children treated with reduced-dose CSRT followed by HDCT and ASCR warrant further exploration in a larger study population.

No MeSH data available.


Related in: MedlinePlus