TY - JOUR
T1 - Hyperfractionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma
T2 - Results from the randomized multicenter HIT-SIOP PNET 4 trial
AU - Lannering, Birgitta
AU - Rutkowski, Stefan
AU - Doz, Francois
AU - Pizer, Barry
AU - Gustafsson, Göran
AU - Navajas, Aurora
AU - Massimino, Maura
AU - Reddingius, Roel
AU - Benesch, Martin
AU - Carrie, Christian
AU - Taylor, Roger
AU - Gandola, Lorenza
AU - Bjor̈k-Eriksson, Thomas
AU - Giralt, Jordi
AU - Oldenburger, Foppe
AU - Pietsch, Torsten
AU - Figarella-Branger, Dominique
AU - Robson, Keith
AU - Forni, Marco
AU - Clifford, Steven C.
AU - Warmuth-Metz, Monica
AU - Von Hoff, Katja
AU - Faldum, Andreas
AU - Mosseri, Véronique
AU - Kortmann, Rolf
N1 - Copyright © 2023 American Society of Clinical Oncology
PY - 2012/8/10
Y1 - 2012/8/10
N2 - Purpose: To compare event-free survival (EFS), overall survival (OS), pattern of relapse, and hearing loss in children with standard-risk medulloblastoma treated by postoperative hyperfractionated or conventionally fractionated radiotherapy followed by maintenance chemotherapy. Patients and Methods: In all, 340 children age 4 to 21 years from 122 European centers were postoperatively staged and randomly assigned to treatment with hyperfractionated radiotherapy (HFRT) or standard (conventional) fractionated radiotherapy (STRT) followed by a common chemotherapy regimen consisting of eight cycles of cisplatin, lomustine, and vincristine. Results: After a median follow-up of 4.8 years (range, 0.1 to 8.3 years), survival rates were not significantly different between the two treatment arms: 5-year EFS was 77% ± 4% in the STRT group and 78% ± 4% in the HFRT group; corresponding 5-year OS was 87% ± 3% and 85% ± 3%, respectively. A postoperative residual tumor of more than 1.5 cm2 was the strongest negative prognostic factor. EFS of children with all reference assessments and no large residual tumor was 82% ± 2% at 5 years. Patients with a delay of more than 7 weeks to the start of RT had a worse prognosis. Severe hearing loss was not significantly different for the two treatment arms at follow-up. Conclusion: In this large randomized European study, which enrolled patients with standard-risk medulloblastoma from more than 100 centers, excellent survival rates were achieved in patients without a large postoperative residual tumor and without RT treatment delays. EFS and OS for HFRT was not superior to STRT, which therefore remains standard of care in this disease.
AB - Purpose: To compare event-free survival (EFS), overall survival (OS), pattern of relapse, and hearing loss in children with standard-risk medulloblastoma treated by postoperative hyperfractionated or conventionally fractionated radiotherapy followed by maintenance chemotherapy. Patients and Methods: In all, 340 children age 4 to 21 years from 122 European centers were postoperatively staged and randomly assigned to treatment with hyperfractionated radiotherapy (HFRT) or standard (conventional) fractionated radiotherapy (STRT) followed by a common chemotherapy regimen consisting of eight cycles of cisplatin, lomustine, and vincristine. Results: After a median follow-up of 4.8 years (range, 0.1 to 8.3 years), survival rates were not significantly different between the two treatment arms: 5-year EFS was 77% ± 4% in the STRT group and 78% ± 4% in the HFRT group; corresponding 5-year OS was 87% ± 3% and 85% ± 3%, respectively. A postoperative residual tumor of more than 1.5 cm2 was the strongest negative prognostic factor. EFS of children with all reference assessments and no large residual tumor was 82% ± 2% at 5 years. Patients with a delay of more than 7 weeks to the start of RT had a worse prognosis. Severe hearing loss was not significantly different for the two treatment arms at follow-up. Conclusion: In this large randomized European study, which enrolled patients with standard-risk medulloblastoma from more than 100 centers, excellent survival rates were achieved in patients without a large postoperative residual tumor and without RT treatment delays. EFS and OS for HFRT was not superior to STRT, which therefore remains standard of care in this disease.
UR - http://www.scopus.com/inward/record.url?scp=84866532813&partnerID=8YFLogxK
U2 - 10.1200/JCO.2011.39.8719
DO - 10.1200/JCO.2011.39.8719
M3 - Article
C2 - 22851561
AN - SCOPUS:84866532813
SN - 0732-183X
VL - 30
SP - 3187
EP - 3193
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 26
ER -