The treatment of medulloblastoma

Results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine, and prednisone

Audrey E. EvansThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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R. Derek T. JenkinThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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Richard SpostoThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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Jorge A. OrtegaThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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Charles B. WilsonThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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William WaraThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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Inta J. ErtelThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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Simon KramerThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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Chu H. ChangThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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Sanford L. LeikinThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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G. Denman HammondThe Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Toronto-Bayview Cancer Center, Toronto, Ontario, Canada; University of Southern California School of Medicine and Children's Hospital of Los Angeles, Los Angeles, California; University of California, San Francisco, California; University of Michigan, Ann Arbor, Michigan; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Columbia-Presbyterian Medical Center, New York, New York; and Children's Hospital National Medical Center, Washington, D.C.

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✓ In a prospective randomized trial designed to study the effectiveness of adjuvant chemotherapy following standard surgical treatment and radiation therapy, 233 eligible patients with medulloblastoma were treated by members of the Childrens Cancer Study Group and the Radiation Therapy Oncology Group. Eligible patients were randomly assigned to receive radiation therapy with or without adjuvant chemotherapy consisting of 1-(2-chloroethyl)-3-cyclohexyl-nitrosourea (CCNU), vincristine, and prednisone. The estimated 5-year event-free survival probability was 59% for patients treated with radiation therapy and chemotherapy and 50% for patients treated with radiation therapy alone, a difference which is not statistically significant. The 5-year survival probability was 65% for both groups. Although the treatment difference was not statistically significant when all patients were combined, in the small number of patients with more extensive tumors, event-free survival was better in the group receiving chemotherapy (48% vs. 0%, p = 0.006). In these latter patients the survival time is also significantly prolonged. Extent of disease (as measured by the M staging criteria described by Chang) and age at diagnosis were significantly associated with outcome; advanced disease and young age had a worse prognosis. The extent of tumor resection was not an independent prognostic factor. It is concluded that chemotherapy does not benefit patients with low-stage medulloblastoma, but may benefit those with more advanced stages of disease.

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