Sindu Vivekanandan1, Richard Breene2, Ramya Ramanujachar3, Heidi Traunecker4, Barry Pizer5, Mark N Gaze6, Frank Saran7, Nicky Thorp8, Martin English9, Kate Ah Wheeler10, Antony Michalski11, David A Walker12, Daniel Saunders13, Fiona Cowie14, Alison Cameron15, Susan V Picton16, Deepak Parashar17, Gail Horan1, Michael V Williams1. 1. Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK. 2. Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK. 3. Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 4. Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK. 5. Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK. 6. Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK. 7. Clinical Oncology, The Royal Marsden NHS Foundation Trust, Surrey, UK. 8. Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK. 9. Paediatric Oncology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK. 10. Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 11. Paediatric Oncology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK. 12. Paediatric Oncology, Nottingham Children's Hospital University of Nottingham, Nottingham, UK. 13. Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK. 14. Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK. 15. Clinical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 16. Paediatric Oncology, The Leeds Teaching Hospitals, Leeds, UK. 17. Cancer Research Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
Abstract
BACKGROUND: Historically, the 5-year overall survival (OS) for metastatic medulloblastoma (MMB) was less than 40%. The strategy of post-operative induction chemotherapy (IC) followed by hyperfractionated accelerated radiotherapy (HART) and response directed high dose chemotherapy (HDC) was reported in a single center study to improve 5-year OS to 73%. We report outcomes of this strategy in UK. METHODS: Questionnaires were sent to all 20 UK pediatric oncology primary treatment centers to collect retrospective data on delivered treatment, toxicity and survival with this strategy in children aged 3-19 years with MMB. RESULTS: Between February 2009 and October 2011, 34 patients fulfilled the entry criteria of the original study. The median age was 7 years (range 3-15). Median interval from surgery to HART was 109 versus 85 days in the original series. The incidence of grade 3 or 4 hematological toxicities with IC and HDC was 83-100%. All 16 patients who achieved complete response by the end of the regimen remain in remission but only three of 18 patients with lesser responses are still alive (P < 0.0001). With a median follow-up of 45 months for survivors, the estimated 3-year OS is 56% (95% CI 38, 71). This result is outside the 95% CI of the original study results and encompasses the historical survival result of 40%. CONCLUSION: Within the limits of statistical significance, we did not replicate the improved survival results reported in the original series. The reasons include differences in patient sub-groups and protocol administration. International randomized phase III studies are needed.
BACKGROUND: Historically, the 5-year overall survival (OS) for metastatic medulloblastoma (MMB) was less than 40%. The strategy of post-operative induction chemotherapy (IC) followed by hyperfractionated accelerated radiotherapy (HART) and response directed high dose chemotherapy (HDC) was reported in a single center study to improve 5-year OS to 73%. We report outcomes of this strategy in UK. METHODS: Questionnaires were sent to all 20 UK pediatric oncology primary treatment centers to collect retrospective data on delivered treatment, toxicity and survival with this strategy in children aged 3-19 years with MMB. RESULTS: Between February 2009 and October 2011, 34 patients fulfilled the entry criteria of the original study. The median age was 7 years (range 3-15). Median interval from surgery to HART was 109 versus 85 days in the original series. The incidence of grade 3 or 4 hematological toxicities with IC and HDC was 83-100%. All 16 patients who achieved complete response by the end of the regimen remain in remission but only three of 18 patients with lesser responses are still alive (P < 0.0001). With a median follow-up of 45 months for survivors, the estimated 3-year OS is 56% (95% CI 38, 71). This result is outside the 95% CI of the original study results and encompasses the historical survival result of 40%. CONCLUSION: Within the limits of statistical significance, we did not replicate the improved survival results reported in the original series. The reasons include differences in patient sub-groups and protocol administration. International randomized phase III studies are needed.
Authors: Maria Camilla Rossi Espagnet; Luca Pasquini; Antonio Napolitano; Antonella Cacchione; Angela Mastronuzzi; Roberta Caruso; Paolo Tomà; Daniela Longo Journal: Pediatr Radiol Date: 2016-12-09
Authors: Teresa de Rojas; Francisco Bautista; Miguel Flores; Lucía Igual; Raquel Rubio; Eduardo Bardón; Lucía Navarro; Laura Murillo; Raquel Hladun; Adela Cañete; Miguel Garcia-Ariza; Carmen Garrido; Ana Fernández-Teijeiro; Eduardo Quiroga; Carlota Calvo; Anna Llort; Inmaculada de Prada; Luis Madero; Ofelia Cruz; Lucas Moreno Journal: J Neurooncol Date: 2017-12-16 Impact factor: 4.130