Treatment strategies for high-risk medulloblastoma and supratentorial primitive neuroectodermal tumors

Review of the literature

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P Primitive neuroectodermal tumors (PNETs) are malignant tumors with a high propensity to disseminate throughout the cerebrospinal fluid. Current treatment guidelines are largely determined by clinically based prognostic factors, the most important of which are tumor location and the extent of tumor spread. Although the cure rate for high-risk PNETs has improved, the irreversible sequelae of craniospinal axis radiation treatment in patients who survive have motivated researchers to investigate more fully which patients can safely receive less treatment. The author reviews the literature, describes currently available treatment options for patients with high-risk PNETs, and discusses strategies aimed at improving outcome and refining prognosis that are currently being explored.

Article Information

Contributor Notes

Address reprint requests to: Regina I. Jakacki, M.D., Division of Hematology/Oncology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, Pennsylvania 15213. email: regina.jakacki@chp.edu.
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References
  • 1.

    Albright ALWisoff JHZeltzer PBoyett JRorke LBStanley Pet al: Prognostic factors in children with supratentorial (nonpineal) primitive neuroectodermal tumors: a neurosurgical perspective from the Children's Cancer Group. Pediatr Neurosurg 22:171995Albright AL Wisoff JH Zeltzer P Boyett J Rorke LB Stanley P et al: Prognostic factors in children with supratentorial (nonpineal) primitive neuroectodermal tumors: a neurosurgical perspective from the Children's Cancer Group. Pediatr Neurosurg 22:1–7 1995

    • Search Google Scholar
    • Export Citation
  • 2.

    Allen JPrados MDonahue BMehta MRobertson PJakacki Ret al: A Phase I/II study for newly diagnosed high risk PNET consisting of neoadjuvant chemotherapy (CHT) followed by hyperfractionated radiotherapy (RT): preliminary results of CCG 9931. Neuro-oncology 2:2472000 (Abstract)Allen J Prados M Donahue B Mehta M Robertson P Jakacki R et al: A Phase I/II study for newly diagnosed high risk PNET consisting of neoadjuvant chemotherapy (CHT) followed by hyperfractionated radiotherapy (RT): preliminary results of CCG 9931. Neuro-oncology 2:247 2000 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 3.

    Allen JCDonahue BDaRosso RNirenberg A: Hyperfractionated craniospinal radiotherapy and adjuvant chemotherapy for children with newly diagnosed medulloblastoma and other primitive neuroectodermal tumors. Int J Radiat Oncol Biol Phys 36:115511611996Allen JC Donahue B DaRosso R Nirenberg A: Hyperfractionated craniospinal radiotherapy and adjuvant chemotherapy for children with newly diagnosed medulloblastoma and other primitive neuroectodermal tumors. Int J Radiat Oncol Biol Phys 36:1155–1161 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    Ashwal SHinshaw DB JrBedros A: CNS primitive neuroectodermal tumors of childhood. Med Pediatr Oncol 12:1801881984Ashwal S Hinshaw DB Jr Bedros A: CNS primitive neuroectodermal tumors of childhood. Med Pediatr Oncol 12:180–188 1984

    • Search Google Scholar
    • Export Citation
  • 5.

    Bailey PCushing H: Medulloblastoma cerebelli: a common type of mid-cerebellar glioma of childhood. Arch Neurol Psychiatr 14:1922231925Bailey P Cushing H: Medulloblastoma cerebelli: a common type of mid-cerebellar glioma of childhood. Arch Neurol Psychiatr 14:192–223 1925

    • Search Google Scholar
    • Export Citation
  • 6.

    Berger MSEdwards MSWara WMLevin VAWilson CB: Primary cerebral neuroblastoma. Long-term follow-up review and therapeutic guidelines. J Neurosurg 59:4184231983Berger MS Edwards MS Wara WM Levin VA Wilson CB: Primary cerebral neuroblastoma. Long-term follow-up review and therapeutic guidelines. J Neurosurg 59:418–423 1983

    • Search Google Scholar
    • Export Citation
  • 7.

    Bouffet EGenet JCDoz FTron PRoche HPlantaz Det al: Metastic medulloblastoma: the experience of the French Cooperative M7 Group. Eur J Cancer 30A:147814831994Bouffet E Genet JC Doz F Tron P Roche H Plantaz D et al: Metastic medulloblastoma: the experience of the French Cooperative M7 Group. Eur J Cancer 30A:1478–1483 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Brown HGKepner JLPerlman EJFriedman HSStrother DRDuffner PKet al: “Large cell/anaplastic” medulloblastomas: a Pediatric Oncology Group Study. J Neuropathol Exp Neurol 59:8578652000Brown HG Kepner JL Perlman EJ Friedman HS Strother DR Duffner PK et al: “Large cell/anaplastic” medulloblastomas: a Pediatric Oncology Group Study. J Neuropathol Exp Neurol 59:857–865 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    Burnett MEWhite ECSih Svon Haken MSCogen PH: Chromosome arm 17p deletion analysis reveals molecular genetic heterogeneity in supratentorial and infratentorial primitive neuroectodermal tumors of the central nervous system. Cancer Genet Cytogenet 97:25311997Burnett ME White EC Sih S von*Haken MS Cogen PH: Chromosome arm 17p deletion analysis reveals molecular genetic heterogeneity in supratentorial and infratentorial primitive neuroectodermal tumors of the central nervous system. Cancer Genet Cytogenet 97:25–31 1997

    • Search Google Scholar
    • Export Citation
  • 10.

    Chang CHHousepian EMHerbert C Jr: An operative staging system and a megavoltage radiotherapeutic technique for cerebellar medulloblastomas. Radiology 93:135113591969Chang CH Housepian EM Herbert C Jr: An operative staging system and a megavoltage radiotherapeutic technique for cerebellar medulloblastomas. Radiology 93:1351–1359 1969

    • Search Google Scholar
    • Export Citation
  • 11.

    Cohen BHZeltzer PMBoyett JMGeyer JRAllen JCFinlay JLet al: Prognostic factors and treatment results for supratentorial primitive neuroectodermal tumors in children using radiation and chemotherapy: a Childrens Cancer Group randomized trial. J Clin Oncol 13:168716961995Cohen BH Zeltzer PM Boyett JM Geyer JR Allen JC Finlay JL et al: Prognostic factors and treatment results for supratentorial primitive neuroectodermal tumors in children using radiation and chemotherapy: a Childrens Cancer Group randomized trial. J Clin Oncol 13:1687–1696 1995

    • Search Google Scholar
    • Export Citation
  • 12.

    Dirks PBHarris LHoffman HJHumphreys RPDrake JMRutka JT: Supratentorial primitive neuroectodermal tumors in children. J Neurooncol 29:75841996Dirks PB Harris L Hoffman HJ Humphreys RP Drake JM Rutka JT: Supratentorial primitive neuroectodermal tumors in children. J Neurooncol 29:75–84 1996

    • Search Google Scholar
    • Export Citation
  • 13.

    Duffner PKCohen MESanford RAHorowitz MEKrischer JPBurger PCet al: Lack of efficacy of postoperative chemotherapy and delayed radiation in very young children with pineoblastoma. Pediatric Oncology Group. Med Pediatr Oncol 25:38441995Duffner PK Cohen ME Sanford RA Horowitz ME Krischer JP Burger PC et al: Lack of efficacy of postoperative chemotherapy and delayed radiation in very young children with pineoblastoma. Pediatric Oncology Group. Med Pediatr Oncol 25:38–44 1995

    • Search Google Scholar
    • Export Citation
  • 14.

    Duffner PKHorowitz MEKrischer JPFriedman HSBurger PCCohen MEet al: Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. New Engl J Med 328:17251731199314. Duffner PK Horowitz ME Krischer JP Friedman HS Burger PC Cohen ME et al: Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. New Engl J Med 328:1725–1731 1993

    • Search Google Scholar
    • Export Citation
  • 15.

    Eberhart CGKepner JLGoldthwaite PTKun LEDuffner PKFriedman HSet al: Histopathologic grading of medulloblastomas: a Pediatric Oncology Group study. Cancer 94:5525602002Eberhart CG Kepner JL Goldthwaite PT Kun LE Duffner PK Friedman HS et al: Histopathologic grading of medulloblastomas: a Pediatric Oncology Group study. Cancer 94:552–560 2002

    • Search Google Scholar
    • Export Citation
  • 16.

    Evans AEJenkin RDSposto ROrtega JAWilson CBWara Wet al: The treatment of medulloblastoma. Results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine, and prednisone. J Neurosurg 72:5725821990Evans AE Jenkin RD Sposto R Ortega JA Wilson CB Wara W et al: The treatment of medulloblastoma. Results of a prospective randomized trial of radiation therapy with and without CCNU vincristine and prednisone. J Neurosurg 72:572–582 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Friedman HSSchold SC Jr: Rational approaches to the che motherapy of medulloblastoma. Neurol Clin 3:8438531985Friedman HS Schold SC Jr: Rational approaches to the che motherapy of medulloblastoma. Neurol Clin 3:843–853 1985

    • Search Google Scholar
    • Export Citation
  • 18.

    Gaffney CCSloane JPBradley NJBloom HJ: Primitive neuroectodermal tumours of the cerebrum. Pathology and treatment. J Neurooncol 3:23331985Gaffney CC Sloane JP Bradley NJ Bloom HJ: Primitive neuroectodermal tumours of the cerebrum. Pathology and treatment. J Neurooncol 3:23–33 1985

    • Search Google Scholar
    • Export Citation
  • 19.

    Gajjar ASanford RABhargava RHeideman RWalter ALi Yet al: Medulloblastoma with brain stem involvement: the impact of gross total resection on outcome. Pediatr Neurosurg 25:1821871996Gajjar A Sanford RA Bhargava R Heideman R Walter A Li Y et al: Medulloblastoma with brain stem involvement: the impact of gross total resection on outcome. Pediatr Neurosurg 25:182–187 1996

    • Search Google Scholar
    • Export Citation
  • 20.

    Geyer JRZeltzer PMBoyett JMRorke LBStanley PAlbright ALet al: Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNS treated with eight drugs in 1 day: a report from the Childrens Cancer Group. J Clin Oncol 12:160716151994Geyer JR Zeltzer PM Boyett JM Rorke LB Stanley P Albright AL et al: Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNS treated with eight drugs in 1 day: a report from the Childrens Cancer Group. J Clin Oncol 12:1607–1615 1994

    • Search Google Scholar
    • Export Citation
  • 21.

    Gilbertson RWickramasinghe CHernan RBalaji VHunt DJones-Wallace Det al: Clinical and molecular stratification of disease risk in medulloblastoma. Br J Cancer 85:7057122001Gilbertson R Wickramasinghe C Hernan R Balaji V Hunt D Jones-Wallace D et al: Clinical and molecular stratification of disease risk in medulloblastoma. Br J Cancer 85:705–712 2001

    • Search Google Scholar
    • Export Citation
  • 22.

    Grotzer MAJanss AJFung KMBiegel JASutton LNRorke LBet al: TrkC expression predicts good clinical outcome in primitive neuroectodermal brain tumors. J Clin Oncol 18:102710352000Grotzer MA Janss AJ Fung KM Biegel JA Sutton LN Rorke LB et al: TrkC expression predicts good clinical outcome in primitive neuroectodermal brain tumors. J Clin Oncol 18:1027–1035 2000

    • Search Google Scholar
    • Export Citation
  • 23.

    Hallahan ARPritchard JIChandraratna RAEllenbogen RGGeyer JROverland RPet al: BMP-2 mediates retinoid-induced apoptosis in medulloblastoma cells through a paracrine effect. Nat Med 9:103310382003Hallahan AR Pritchard JI Chandraratna RA Ellenbogen RG Geyer JR Overland RP et al: BMP-2 mediates retinoid-induced apoptosis in medulloblastoma cells through a paracrine effect. Nat Med 9:1033–1038 2003

    • Search Google Scholar
    • Export Citation
  • 24.

    Jakacki RIZeltzer PMBoyett JMAlbright ALAllen JCGeyer JRet al: Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: a report of the Childrens Cancer Group. J Clin Oncol 13:137713831995Jakacki RI Zeltzer PM Boyett JM Albright AL Allen JC Geyer JR et al: Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: a report of the Childrens Cancer Group. J Clin Oncol 13:1377–1383 1995

    • Search Google Scholar
    • Export Citation
  • 25.

    Janss AJYachnis ATSilber JHTrojanowski JQLee VMSutton LNet al: Glial differentiation predicts poor clinical outcome in primitive neuroectodermal brain tumors. Ann Neurol 39:4814891996Janss AJ Yachnis AT Silber JH Trojanowski JQ Lee VM Sutton LN et al: Glial differentiation predicts poor clinical outcome in primitive neuroectodermal brain tumors. Ann Neurol 39:481–489 1996

    • Search Google Scholar
    • Export Citation
  • 26.

    Kleihues PBurger PCScheithauer BW (eds): Histologic Typing of Tumors of the Central Nervous Systemed 2. Vienna: Springer-Verlag1993Kleihues P Burger PC Scheithauer BW (eds): Histologic Typing of Tumors of the Central Nervous System ed 2. Vienna: Springer-Verlag 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Kortmann RDKuhl JTimmermann BMittler UUrban CBudach Vet al: Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT 91.‘Int J Radiat Oncol Biol Phys 46:2692792000Kortmann RD Kuhl J Timmermann B Mittler U Urban C Budach V et al: Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT 91.‘Int J Radiat Oncol Biol Phys 46:269–279 2000

    • Search Google Scholar
    • Export Citation
  • 28.

    Kuhl JKortmann RDMittler UUrban CHDeinlein FBecker Jet al: Preradiation (PRE-RT-C) versus postradiation (POST-RT-C) chemotherapy in standard-risk medulloblastoma (SRMB): final results of the HIT'91 trial. Neurooncol 5:502003Kuhl J Kortmann RD Mttler U Urban CH Deinlein F Becker J et al: Preradiation (PRE-RT-C) versus postradiation (POST-RT-C) chemotherapy in standard-risk medulloblastoma (SRMB): final results of the HIT'91 trial. Neurooncol 5:50 2003

    • Search Google Scholar
    • Export Citation
  • 29.

    Kuhl JMuller HLBerthold FKortmann RDDeinlein FMaass Eet al: Preradiation chemotherapy of children and young adults with malignant brain tumors: results of the German pilot trial HIT ‘88/’89. Klin Pediatr 210:2272331998Kuhl J Muller HL Berthold F Kortmann RD Deinlein F Maass E et al: Preradiation chemotherapy of children and young adults with malignant brain tumors: results of the German pilot trial HIT ‘88/’89. Klin Pediatr 210:227–233 1998

    • Search Google Scholar
    • Export Citation
  • 30.

    Leonard JRCai DXRivet DJKaufman BAPark TSLevy BKet al: Large cell/anaplastic medulloblastomas and medullomyoblastomas: clinicopathological and genetic features. J Neurosurg 95:82882001Leonard JR Cai DX Rivet DJ Kaufman BA Park TS Levy BK et al: Large cell/anaplastic medulloblastomas and medullomyoblastomas: clinicopathological and genetic features. J Neurosurg 95:82–88 2001

    • Search Google Scholar
    • Export Citation
  • 31.

    MacDonald TJBrown KMLaFleur BPeterson KLawlor CChen Yet al: Expression profiling of medulloblastoma: PDGFRA and the RAS/MAPK pathway as therapeutic targets for metastatic disease. Nat Genet 29:1431522001MacDonald TJ Brown KM LaFleur B Peterson K Lawlor C Chen Y et al: Expression profiling of medulloblastoma: PDGFRA and the RAS/MAPK pathway as therapeutic targets for metastatic disease. Nat Genet 29:143–152 2001

    • Search Google Scholar
    • Export Citation
  • 32.

    Marec-Berard PJouvet AThiesse PKalifa CDoz FFrappaz D: Supratentorial embryonal tumors in children under 5 years of age: an SFOP study of treatment with postoperative chemotherapy alone. Med Pediatr Oncol 38:83902002Marec-Berard P Jouvet A Thiesse P Kalifa C Doz F Frappaz D: Supratentorial embryonal tumors in children under 5 years of age: an SFOP study of treatment with postoperative chemotherapy alone. Med Pediatr Oncol 38:83–90 2002

    • Search Google Scholar
    • Export Citation
  • 33.

    Mastrangelo RLasorella ARiccardi RColosimo CIavarone ATornesello Aet al: Carboplatin in childhood medulloblastoma/PNET: feasibility of an in vivo sensitivity test in an “upfront” study. Med Pediatr Oncol 24:1881961995Mastrangelo R Lasorella A Riccardi R Colosimo C Iavarone A Tornesello A et al: Carboplatin in childhood medulloblastoma/PNET: feasibility of an in vivo sensitivity test in an “upfront” study. Med Pediatr Oncol 24:188–196 1995

    • Search Google Scholar
    • Export Citation
  • 34.

    Mosijczuk ADNigro MAThomas PRBurger PCKrischer JPMorantz RAet al: Preradiation chemotherapy in advanced medulloblastoma: a Pediatric Oncology Group pilot study. Cancer 72:275527621993Mosijczuk AD Nigro MA Thomas PR Burger PC Krischer JP Morantz RA et al: Preradiation chemotherapy in advanced medulloblastoma: a Pediatric Oncology Group pilot study. Cancer 72:2755–2762 1993

    • Search Google Scholar
    • Export Citation
  • 35.

    Packer RJGoldwein JNicholson HSVezina LGAllen JCRis MDet al: Treatment of children with medulloblastomas with reduced-dose craniospinal radition therapy and adjuvant chemotherapy: a Children's Cancer Group Study. J Clin Oncol 17:212721361999Packer RJ Goldwein J Nicholson HS Vezina LG Allen JC Ris MD et al: Treatment of children with medulloblastomas with reduced-dose craniospinal radition therapy and adjuvant chemotherapy: a Children's Cancer Group Study. J Clin Oncol 17:2127–2136 1999

    • Search Google Scholar
    • Export Citation
  • 36.

    Packer RJSutton LNElterman RLange BGoldwein JNicholson HSet al: Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy. J Neurosurg 81:6906981994Packer RJ Sutton LN Elterman R Lange B Goldwein J Nicholson HS et al: Outcome for children with medulloblastoma treated with radiation and cisplatin CCNU and vincristine chemotherapy. J Neurosurg 81:690–698 1994

    • Search Google Scholar
    • Export Citation
  • 37.

    Paulino ACMelian E: Medulloblastoma and supratentorial primitive neuroectodermal tumors: an institutional experience. Cancer 86:1421481999Paulino AC Melian E: Medulloblastoma and supratentorial primitive neuroectodermal tumors: an institutional experience. Cancer 86:142–148 1999

    • Search Google Scholar
    • Export Citation
  • 38.

    Pomeroy SLTamayo PGaasenbeek MSturia LMAngelo MMcLaughlin MEet al: Prediction of central nervous system embryonal tumour outcome based on gene expression. Nature 415:4364422002Pomeroy SL Tamayo P Gaasenbeek M Sturia LM Angelo M McLaughlin ME et al: Prediction of central nervous system embryonal tumour outcome based on gene expression. Nature 415:436–442 2002

    • Search Google Scholar
    • Export Citation
  • 39.

    Prados MDWara WEdwards MSAter JRabbit JLamborn Ket al: Treatment of high-risk meduloblastoma and other primitive neuroectodermal tumors with reduced dose craniospinal radiation therapy and multi-agent nitrosourea-based chemotherapy. Pediatr Neurosurg 25:1741811996Prados MD Wara W Edwards MS Ater J Rabbit J Lamborn K et al: Treatment of high-risk meduloblastoma and other primitive neuroectodermal tumors with reduced dose craniospinal radiation therapy and multi-agent nitrosourea-based chemotherapy. Pediatr Neurosurg 25:174–181 1996

    • Search Google Scholar
    • Export Citation
  • 40.

    Reddy ATJanss AJPhillips PCWeiss HLPacker RJ: Outcome for children with supratentorial primitive neuroectodermal tumors treated with surgery, radiation, and chemotherapy. Cancer 88:218921932000Reddy AT Janss AJ Phillips PC Weiss HL Packer RJ: Outcome for children with supratentorial primitive neuroectodermal tumors treated with surgery radiation and chemotherapy. Cancer 88:2189–2193 2000

    • Search Google Scholar
    • Export Citation
  • 41.

    Rorke LB: The cerebral medulloblastoma and its relationship to primitive neuroectodermal tumors. J Neuropathol Exp Neurol 42:1151983Rorke LB: The cerebral medulloblastoma and its relationship to primitive neuroectodermal tumors. J Neuropathol Exp Neurol 42:1–15 1983

    • Search Google Scholar
    • Export Citation
  • 42.

    Russo CPellarin MTingby OBollen AWLamborn KRMohapatra Get al: Comparative genomic hybridization in patients with supratentorial and infratentorial primitive neuroectodermal tumors. Cancer 86:3313391999Russo C Pellarin M Tingby O Bollen AW Lamborn KR Mohapatra G et al: Comparative genomic hybridization in patients with supratentorial and infratentorial primitive neuroectodermal tumors. Cancer 86:331–339 1999

    • Search Google Scholar
    • Export Citation
  • 43.

    Segal RGoumnerova LCKwon YKStiles CDPomeroy SL: Expression of the neutrotrophin receptor TrkC is linked to a favorable outcome in medulloblastoma. Proc Natl Acad Sci USA 91:12867128711994Segal R Goumnerova LC Kwon YK Stiles CD Pomeroy SL: Expression of the neutrotrophin receptor TrkC is linked to a favorable outcome in medulloblastoma. Proc Natl Acad Sci USA 91:12867–12871 1994

    • Search Google Scholar
    • Export Citation
  • 44.

    Skov KMacPhail S: Interaction of platinum drugs with clinically relevant x-ray doses in mammalian cells: a comparison of cisplatin, carboplatin, iproplatin, and tetraplatin. Int J Radiat Oncol Biol Phys 20:2212251991Skov K MacPhail S: Interaction of platinum drugs with clinically relevant x-ray doses in mammalian cells: a comparison of cisplatin carboplatin iproplatin and tetraplatin. Int J Radiat Oncol Biol Phys 20:221–225 1991

    • Search Google Scholar
    • Export Citation
  • 45.

    Strother DAshley DKellie SJPatel AJones-Wallace DThompson Set al: Feasibility of four consecutive high-dose chemotherapy cycles with stem cell rescue for patients with newly diagnosed medulloblastoma or supratentorial primitive neuroectodermal tumor after craniospinal radiotherapy: results of a collaborative study. J Clin Oncol 19:269627042001Strother D Ashley D Kellie SJ Patel A Jones-Wallace D Thompson S et al: Feasibility of four consecutive high-dose chemotherapy cycles with stem cell rescue for patients with newly diagnosed medulloblastoma or supratentorial primitive neuroectodermal tumor after craniospinal radiotherapy: results of a collaborative study. J Clin Oncol 19:2696–2704 2001

    • Search Google Scholar
    • Export Citation
  • 46.

    Thames HD JrWithers HRPeter LJFletcher GH: Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys 8:2192261982Thames HD Jr Withers HR Peter LJ Fletcher GH: Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys 8:219–226 1982

    • Search Google Scholar
    • Export Citation
  • 47.

    Timmermann BKortmann RDKuhl JMeisner CDieckmann KPietsch Tet al: Role of radiotherapy in the treatment of supratentorial primitive neuroectodermal tumors in childhood: results of the prospective German brain tumor trials HIT 88/89 and 91. J Clin Oncol 20:8428492002Timmermann B Kortmann RD Kuhl J Meisner C Dieckmann K Pietsch T et al: Role of radiotherapy in the treatment of supratentorial primitive neuroectodermal tumors in childhood: results of the prospective German brain tumor trials HIT 88/89 and 91. J Clin Oncol 20:842–849 2002

    • Search Google Scholar
    • Export Citation
  • 48.

    Tomita TMcLone DGYasue M: Cerebral primitive neuroectodomeral tumors in childhood. J Neurooncol 6:2332431988Tomita T McLone DG Yasue M: Cerebral primitive neuroectodomeral tumors in childhood. J Neurooncol 6:233–243 1988

    • Search Google Scholar
    • Export Citation
  • 49.

    Wheldon TEO'Donohue JABarrett A: Kinetic considerations in the choice of treatment schedules for neuraxis radtiotherapy. Br J Radiol 66:1661993Wheldon TE O'Donohue JA Barrett A: Kinetic considerations in the choice of treatment schedules for neuraxis radtiotherapy. Br J Radiol 66:1–66 1993

    • Search Google Scholar
    • Export Citation
  • 50.

    Yang HJNam DHWang KCKim YMChi JGCho BK: Supratentorial primitive neuroectodermal tumor in children: clinical features, treatment outcome and prognostic factors. Childs Nerv Syst 15:3773831999Yang HJ Nam DH Wang KC Kim YM Chi JG Cho BK: Supratentorial primitive neuroectodermal tumor in children: clinical features treatment outcome and prognostic factors. Childs Nerv Syst 15:377–383 1999

    • Search Google Scholar
    • Export Citation
  • 51.

    Yao MSMehta MPBoyett JMLi HDonahue BRorke LBet al: The effect of M-stage on patterns of failure in posterior fossa primitive neuroectodermal tumors treated on CCG-921: a phase III study in a high-risk patient population. Int J Radiat Oncol Biol Phys 38:4694761997Yao MS Mehta MP Boyett JM Li H Donahue B Rorke LB et al: The effect of M-stage on patterns of failure in posterior fossa primitive neuroectodermal tumors treated on CCG-921: a phase III study in a high-risk patient population. Int J Radiat Oncol Biol Phys 38:469–476 1997

    • Search Google Scholar
    • Export Citation
  • 52.

    Yock TIFriedman HKun LKepner JBarnes PTarbell NJ: Response to pre-radiation chemotherapy is predictive of improved survival in high risk medulloblastoma: results from Pediatric Oncology Group (POG 9031). Int J Radiat Oncol Biol Phys 51:1201212001(Abstract)Yock TI Friedman H Kun L Kepner J Barnes P Tarbell NJ: Response to pre-radiation chemotherapy is predictive of improved survival in high risk medulloblastoma: results from Pediatric Oncology Group (POG 9031). Int J Radiat Oncol Biol Phys 51:120–121 2001 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 53.

    Zeltzer PMBoyett JMFinlay JLAlbright ALRorke LBMilstein JMet al: Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children's Cancer Group 921 randomized phase III study. J Clin Oncol 17:8328451999Zeltzer PM Boyett JM Finlay JL Albright AL Rorke LB Milstein JM et al: Metastasis stage adjuvant treatment and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children's Cancer Group 921 randomized phase III study. J Clin Oncol 17:832–845 1999

    • Search Google Scholar
    • Export Citation
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