TY - JOUR
T1 - Hyperfractionated Versus Conventional Radiotherapy Followed by Chemotherapy in Standard-Risk Medulloblastoma: Results From the Randomized Multicenter HIT-SIOP PNET 4 Trial
AU - Lannering, Birgitta
AU - Rutkowski, Stefan
AU - Doz, Francois
AU - Pizer, Barry
AU - Gustafsson, Göran
AU - Navajas, Aurora
AU - Massimino, Maura
AU - Reddingius, Roel
AU - Benesch, Martin
AU - Carrie, Christian
AU - Taylor, Roger
AU - Gandola, Lorenza
AU - Björk-Eriksson, Thomas
AU - Giralt, Jordi
AU - Oldenburger, Foppe
AU - Pietsch, Torsten
AU - Figarella-Branger, Dominique
AU - Robson, Keith
AU - Forni, Marco
AU - Clifford, Steven C.
AU - Warmuth-Metz, Monica
AU - von Hoff, Katja
AU - Faldum, Andreas
AU - Mosseri, Véronique
AU - Kortmann, Rolf
PY - 2012
Y1 - 2012
N2 - Purpose To compare event-free survival (EFS), overall survival (OS), pattern of relapse, and hearing loss in children with standard-risk medulloblastoma treated by postoperative hyperfractionated or conventionally fractionated radiotherapy followed by maintenance chemotherapy. Patients and Methods In all, 340 children age 4 to 21 years from 122 European centers were postoperatively staged and randomly assigned to treatment with hyperfractionated radiotherapy (HFRT) or standard (conventional) fractionated radiotherapy (STRT) followed by a common chemotherapy regimen consisting of eight cycles of cisplatin, lomustine, and vincristine. Results After a median follow-up of 4.8 years (range, 0.1 to 8.3 years), survival rates were not significantly different between the two treatment arms: 5-year EFS was 77% +/- 4% in the STRT group and 78% +/- 4% in the HFRT group; corresponding 5-year OS was 87% +/- 3% and 85% +/- 3%, respectively. A postoperative residual tumor of more than 1.5 cm(2) was the strongest negative prognostic factor. EFS of children with all reference assessments and no large residual tumor was 82% +/- 2% at 5 years. Patients with a delay of more than 7 weeks to the start of RT had a worse prognosis. Severe hearing loss was not significantly different for the two treatment arms at follow-up. Conclusion In this large randomized European study, which enrolled patients with standard-risk medulloblastoma from more than 100 centers, excellent survival rates were achieved in patients without a large postoperative residual tumor and without RT treatment delays. EFS and OS for HFRT was not superior to STRT, which therefore remains standard of care in this disease. J Clin Oncol 30:3187-3193. (C) 2012 by American Society of Clinical Oncology
AB - Purpose To compare event-free survival (EFS), overall survival (OS), pattern of relapse, and hearing loss in children with standard-risk medulloblastoma treated by postoperative hyperfractionated or conventionally fractionated radiotherapy followed by maintenance chemotherapy. Patients and Methods In all, 340 children age 4 to 21 years from 122 European centers were postoperatively staged and randomly assigned to treatment with hyperfractionated radiotherapy (HFRT) or standard (conventional) fractionated radiotherapy (STRT) followed by a common chemotherapy regimen consisting of eight cycles of cisplatin, lomustine, and vincristine. Results After a median follow-up of 4.8 years (range, 0.1 to 8.3 years), survival rates were not significantly different between the two treatment arms: 5-year EFS was 77% +/- 4% in the STRT group and 78% +/- 4% in the HFRT group; corresponding 5-year OS was 87% +/- 3% and 85% +/- 3%, respectively. A postoperative residual tumor of more than 1.5 cm(2) was the strongest negative prognostic factor. EFS of children with all reference assessments and no large residual tumor was 82% +/- 2% at 5 years. Patients with a delay of more than 7 weeks to the start of RT had a worse prognosis. Severe hearing loss was not significantly different for the two treatment arms at follow-up. Conclusion In this large randomized European study, which enrolled patients with standard-risk medulloblastoma from more than 100 centers, excellent survival rates were achieved in patients without a large postoperative residual tumor and without RT treatment delays. EFS and OS for HFRT was not superior to STRT, which therefore remains standard of care in this disease. J Clin Oncol 30:3187-3193. (C) 2012 by American Society of Clinical Oncology
U2 - https://doi.org/10.1200/JCO.2011.39.8719
DO - https://doi.org/10.1200/JCO.2011.39.8719
M3 - Article
C2 - 22851561
SN - 0732-183X
VL - 30
SP - 3187
EP - 3193
JO - Journal of clinical oncology
JF - Journal of clinical oncology
IS - 26
ER -