Abstract Objective To retrospectively analyze the impacts of a craniospinal radiation dose ≤24 Gy or>24 Gy on the prognosis of patients with average-risk medulloblastoma. Methods Average-risk medulloblastoma was defined as non-metastatic cancer in children more than 3 years old with complete or near-complete (residual tumor ≤1.5 cm3) resection of tumor. A total of 72 children and adolescents with newly diagnosed average-risk medulloblastoma were enrolled as subjects from 2003 to 2013. After radical resection of the tumor, all patients received craniospinal plus local tumor bed radiotherapy and 8 cycles of adjuvant chemotherapy using cisplatin-, semustine-, or plus vincristine-based regimens. Patients exposed to a radiation dose ≤24 Gy were enrolled into Group A (n=20), while patients exposed to a radiation dose>24 Gy were enrolled into Group B (n=52). The recurrence rate and survival rate were compared between the two groups. The recurrence rate and survival rate were calculated using the Kaplan-Meier method and the differences between the two groups were analyzed using the log-rank test. ResultsPatients in Group A and Group B received craniospinal radiotherapy with a dose of 19.2-24.0 Gy and 24.1-30.6 Gy, respectively. After radiotherapy, 66 patients (92%) completed all adjuvant chemotherapy. A total of 11 patients were recurrence. In all patients, the 3-year sample size was 48;the 3-year event-free survival (EFS) and overall survival (OS) rates were 83% and 86%, respectively. There were no significant differences in the 3-year EFS and OS rates between Group A and Group B (84% vs. 83%, P=0.609;85% vs. 87%, P=0.963). Conclusions The standard comprehensive therapy achieves satisfactory treatment outcomes for average-risk medulloblastoma, in which a craniospinal radiation dose decreased to 19.2-24.0 Gy has no impacts on treatment outcomes.
Zhen Zijun*,Lu Suying,Xia Yunfei et al. Impacts of radiation dose on survival in 72 patients with average-risk medulloblastoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(5): 540-543.
Zhen Zijun*,Lu Suying,Xia Yunfei et al. Impacts of radiation dose on survival in 72 patients with average-risk medulloblastoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(5): 540-543.
[1] Taylor RE,Bailey CC,Robinson KJ,et al. Outcome for patients with metastatic (M2-3) medulloblastoma treated with SIOP/UKCCSG PNET-3 chemotherapy[J].Eur J Cancer,2005,41(5):727-734.DOI:10.1016/j.ejca.2004.12.017. [2] Gajjar A,Chintagumpala M,Ashley D,et al. Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96):long-term results from a prospective,multicentre trial[J].Lancet Oncol,2006,7(10):813-820.DOI:10.1016/S1470-2045(06)70867-1. [3] Tarbell NJ,Friedman H,Polkinghorn WR,et al. High-risk medulloblastoma:a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031)[J].J Clin Oncol,2013,31(23):2936-2941.DOI:10.1200/JCO.2012.43.9984. [4] 张庆慧,苏晓萍,梁思泰,等.210例髓母细胞瘤临床病理研究及预后因素分析[J].中国肿瘤临床与康复,1998,5(4):4-6.DOI:10.13455/j.cnki.cjcor.1998.04.0024. [5] 刘巧丹,张龙丽,丁秋娥,等.夏云飞放疗在髓母细胞瘤治疗中的作用[J].中国神经肿瘤杂志,2012,10(2):96-102. [6] Morris EB,Gajjar A,Okuma JO,et al. Survival and late mortality in long-term survivors of pediatric CNS tumors[J].J Clin Oncol,2007,25(12):1532-1538.DOI:10.1200/JCO.2006.09.8194. [7] Packer RJ,Gajjar A,Vezina G,et al. Phase Ⅲ study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma[J].J Clin Oncol,2006,24(25):4202-4208.DOI:10.1200/JCO.2006.06.4980. [8] Zeltzer PM,Boyett JM,Finlay JL,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].J Clin Oncol,1999,17(3):832-845. [9] Landberg TG,Lindgren ML,Cavallin-Stahl EK,et al. Improvements in the radiotherapy of medulloblastoma,1946-1975[J].Cancer,1980,45(4):670-678.DOI:10.1002/1097-0142(19800215)45:4<670::AID-CNCR2820450409>3.0.CO:2-K. [10] Laughton SJ,Merchant TE,Sklar CA,et al. Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial[J].J Clin Oncol,2008,26(7):1112-1118.DOI:10.1200/JCO.2008.13.5293. [11] Oyharcabal-Bourden V,Kalifa C,Gentet JC,et al. Standard-risk medulloblastoma treated by adjuvant chemotherapy followed by reduced-dose craniospinal radiation therapy:a French Society of Pediatric Oncology Study[J].J Clin Oncol,2005,23(21):4726-4734.DOI:10.1200/JCO.2005.00.760. [12] von Hoff K,Hinkes B,Gerber NU,et al. Long-term outcome and clinical prognostic factors in children with medulloblastoma treated in the prospective randomised multicentre trial HIT′91[J].Eur J Cancer,2009,45(7):1209-1217.DOI:10.1016/j.ejca.2009.01.015. [13] Packer RJ,Siegel KR,Sutton LN,et al. Efficacy of adjuvant chemotherapy for patients with poor-risk medulloblastoma:a preliminary report[J].Ann Neurol,1988,24(4):503-508.DOI:10.1002/ana.410240405. [14] Taylor RE,Bailey CC,Robinson K,et al. Results of a randomized study of preradiation chemotherapy versus radiotherapy alone for nonmetastatic medulloblastoma:the International Society of Paediatric Oncology/United Kingdom Children′s Cancer Study Group PNET-3 Study[J].J Clin Oncol,2003,21(8):1581-1591.DOI:10.1200/JCO.2003.05.116. [15] Massimino M,Antonelli M,Gandola L,et al. Histological variants of medulloblastoma are the most powerful clinical prognostic indicators[J].Pediatr Blood Cancer,2013,60(2):210-216.DOI:10.1002/pbc.24225. [16] Leary SE,Zhou TN,Holmes E,et al. Histology predicts a favorable outcome in young children with desmoplastic medulloblastoma:a report from the children′s oncology group[J].Cancer,2011,117(14):3262-3267.DOI:10.1002/cncr.25856.
2015, Vol. 24 
