High-Risk Medulloblastoma: A Pediatric Oncology Group Randomized Trial of Chemotherapy Before or After Radiation Therapy (POG 9031)

• Type of Material: Article
• Authors: Nancy J. Tarbell, Massachusetts General Hospital; Henry Friedman, Duke University; William R. Polkinghorn, Memorial Sloan Kettering Cancer Center; Torunn Yock, Massachusetts General Hospital; Tianni Zhou, California State University; Zhengjia Chen, Emory University; Peter Burger, Johns Hopkins University; Patrick Barnes, Stanford University; Larry Kun, St. Jude Children’s Research Hospital
• Language: English
• Date: 2013-08-10
• Publisher: American Society of Clinical Oncology
• Publication Version: Final Published Version
• Copyright Statement: © 2013 by American Society of Clinical Oncology.
• Final Published Version (URL): http://dx.doi.org/10.1200/JCO.2012.43.9984
• Title of Journal or Parent Work: Journal of Clinical Oncology
• Volume: 31
• Issue: 23
• Start Page: 2936
• End Page: 2941
• Grant/Funding Information: None declared
• Keywords: radiation; medulloblastoma; children; event-free survival; chemotherapy; high risk
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Radiology; Health Sciences, Oncology; Health Sciences, Human Development

Abstract

Purpose: To compare event-free survival (EFS) in children with high-risk medulloblastoma randomly assigned to receive either chemotherapy before radiation or chemotherapy after radiation. Patients and Methods: One hundred twelve patients were randomly assigned to each arm. Criteria used to categorize patients as high risk included M1-4 disease by modified Chang staging classification, T3b/T4 disease, or greater than 1.5 cm3 of residual tumor after surgery. Postoperatively, children with high-risk medulloblastoma were randomly assigned to two arms, either chemotherapy entailing three cycles of cisplatin and etoposide before radiation (chemotherapy first [CT1]) or the same chemotherapy regimen after radiation (radiation therapy first [RT1]). Both groups received consolidation chemotherapy consisting of vincristine and cyclophosphamide. Results: The median follow-up time was 6.4 years. Five-year EFS was 66.0% in the CT1 arm and 70.0% in the RT1 arm (P = .54), and 5-year overall survival in the two groups was 73.1% and 76.1%, respectively (P = .47). In the CT1 arm, 40 of the 62 patients with residual disease achieved either complete or partial remission. Conclusion: Five-year EFS did not differ significantly whether, after surgery, patients received chemotherapy before or after radiotherapy.