Treatment of medulloblastoma with procarbazine, hydroxyurea, and reduced radiation doses to whole brain and spine

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✓ Forty-seven patients with medulloblastoma were treated postoperatively with procarbazine, followed by craniospinal radiation therapy in combination with hydroxyurea. The radiation dose to the posterior fossa was 55 Gy; the spinal cord received 25 Gy and the whole brain 25 to 35 Gy (mean 33 Gy).

Seventeen tumors recurred. Only one initial recurrence was in the spinal subarachnoid space; 10 (59%) were in the posterior fossa, and four (24%) were supratentorial. The estimated 5-year disease-free survival probability was 55%; the 5-year overall survival rate was 66%. Myelotoxicity occurred in 38% of patients, but in only one case was it severe enough to warrant reducing the total dose of radiation. It was concluded that good-risk medulloblastoma patients may be treated with radiation dosages as low as 25 Gy to the spinal axis and to the whole brain without increasing the risk of recurrence outside the posterior fossa. Chemotherapy with procarbazine followed by radiation therapy and hydroxyurea during radiation therapy was well tolerated and may play a role in reducing radiation dosages outside the posterior fossa.

Article Information

Address for Dr. Liu: Department of Neurology, Veterans General Hospital, Taiwan.

Address for Dr. Fulton: Cross Cancer Center, University of Alberta, Edmonton, Alberta, Canada.

Address reprint requests to: Victor A. Levin, M.D., Brain Tumor Research Center, HSW-783, University of California, San Francisco, California 94143-0520.

© AANS, except where prohibited by US copyright law.

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    Kaplan-Meier curve of estimated survival for the disease-free patients (left) and the entire group (right). Broken line = good-risk patients; solid line = poor-risk patients; and dotted lines = all patients. There were 37 good-risk and 10 poor-risk patients. Ticks indicate censored patients.

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