Preradiation chemotherapy in advanced medulloblastoma

A Pediatric Oncology Group pilot study

A. D. Mosijczuk, M. A. Nigro, P. R M Thomas, P. C. Burger, J. P. Krischer, R. A. Morantz, B. Kurdunowicz, A. F. Mulne, R. B. Towbin, A. I. Freeman, E. D. Nigro, H. S. Friedman, L. E. Kun

Research output: Contribution to journalArticle

Abstract

Background. Children diagnosed with medulloblastoma whose tumor involves the brain stem or has spread through the cerebrospinal fluid pathways to other areas of the brain or spinal cord have a poor prognosis despite therapy with surgery, craniospinal irradiation (CSI), and chemotherapy. Preradiation chemotherapy may improve the outlook for these patients. Methods. To further study the role and feasibility of preradiation chemotherapy, children between the ages of 4 and 21 years diagnosed with advanced medulloblastoma and measurable disease were enrolled in the Pediatric Oncology Group 8695 study. Patients were treated with a 9-week course of vincristine, cisplatin, and cyclophosphamide followed by CSI. Imaging films were reviewed centrally for eligibility and response to chemotherapy. Toxicity to chemotherapy and radiation as well as delays and modifications in subsequent CSI were recorded. Results. Thirteen of 30 fully evaluable patients achieved complete or partial response (43%) to chemotherapy. Toxicity was mostly fever and neutropenia after cyclophosphamide, which is predictable and tolerable. Radiation therapy was delivered in full doses and volumes in most patients but was delayed in its start in most patients. Central review of films revealed frequent use of different imaging modalities at baseline and after therapy, making accurate assessment of tumor response difficult. Conclusion. Preradiation chemotherapy with vincristine, cisplatin, and cyclophosphamide is active in patients with advanced medulloblastoma but should be modified to minimize the risk of progressive disease while on therapy and to avoid delays in starting radiation therapy. Consistent use of the same neuroimaging modality is essential in documenting response.

Original languageEnglish (US)
Pages (from-to)2755-2762
Number of pages8
JournalCancer
Volume72
Issue number9
DOIs
StatePublished - 1993
Externally publishedYes

Fingerprint

Medulloblastoma
Pediatrics
Craniospinal Irradiation
Drug Therapy
Cyclophosphamide
Vincristine
Cisplatin
Radiotherapy
Brain Stem Neoplasms
Feasibility Studies
Motion Pictures
Neutropenia
Neuroimaging
Cerebrospinal Fluid
Spinal Cord
Fever
Therapeutics
Radiation
Brain

Keywords

  • adolescence
  • brain neoplasms
  • child
  • cisplatin
  • combined modality therapy
  • cyclophosphamide
  • drug evaluation
  • medulloblastoma
  • radiation therapy
  • vincristine

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Mosijczuk, A. D., Nigro, M. A., Thomas, P. R. M., Burger, P. C., Krischer, J. P., Morantz, R. A., ... Kun, L. E. (1993). Preradiation chemotherapy in advanced medulloblastoma: A Pediatric Oncology Group pilot study. Cancer, 72(9), 2755-2762. https://doi.org/10.1002/1097-0142(19931101)72:9<2755::AID-CNCR2820720937>3.0.CO;2-V

Preradiation chemotherapy in advanced medulloblastoma : A Pediatric Oncology Group pilot study. / Mosijczuk, A. D.; Nigro, M. A.; Thomas, P. R M; Burger, P. C.; Krischer, J. P.; Morantz, R. A.; Kurdunowicz, B.; Mulne, A. F.; Towbin, R. B.; Freeman, A. I.; Nigro, E. D.; Friedman, H. S.; Kun, L. E.

In: Cancer, Vol. 72, No. 9, 1993, p. 2755-2762.

Research output: Contribution to journalArticle

Mosijczuk, AD, Nigro, MA, Thomas, PRM, Burger, PC, Krischer, JP, Morantz, RA, Kurdunowicz, B, Mulne, AF, Towbin, RB, Freeman, AI, Nigro, ED, Friedman, HS & Kun, LE 1993, 'Preradiation chemotherapy in advanced medulloblastoma: A Pediatric Oncology Group pilot study', Cancer, vol. 72, no. 9, pp. 2755-2762. https://doi.org/10.1002/1097-0142(19931101)72:9<2755::AID-CNCR2820720937>3.0.CO;2-V
Mosijczuk, A. D. ; Nigro, M. A. ; Thomas, P. R M ; Burger, P. C. ; Krischer, J. P. ; Morantz, R. A. ; Kurdunowicz, B. ; Mulne, A. F. ; Towbin, R. B. ; Freeman, A. I. ; Nigro, E. D. ; Friedman, H. S. ; Kun, L. E. / Preradiation chemotherapy in advanced medulloblastoma : A Pediatric Oncology Group pilot study. In: Cancer. 1993 ; Vol. 72, No. 9. pp. 2755-2762.
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abstract = "Background. Children diagnosed with medulloblastoma whose tumor involves the brain stem or has spread through the cerebrospinal fluid pathways to other areas of the brain or spinal cord have a poor prognosis despite therapy with surgery, craniospinal irradiation (CSI), and chemotherapy. Preradiation chemotherapy may improve the outlook for these patients. Methods. To further study the role and feasibility of preradiation chemotherapy, children between the ages of 4 and 21 years diagnosed with advanced medulloblastoma and measurable disease were enrolled in the Pediatric Oncology Group 8695 study. Patients were treated with a 9-week course of vincristine, cisplatin, and cyclophosphamide followed by CSI. Imaging films were reviewed centrally for eligibility and response to chemotherapy. Toxicity to chemotherapy and radiation as well as delays and modifications in subsequent CSI were recorded. Results. Thirteen of 30 fully evaluable patients achieved complete or partial response (43{\%}) to chemotherapy. Toxicity was mostly fever and neutropenia after cyclophosphamide, which is predictable and tolerable. Radiation therapy was delivered in full doses and volumes in most patients but was delayed in its start in most patients. Central review of films revealed frequent use of different imaging modalities at baseline and after therapy, making accurate assessment of tumor response difficult. Conclusion. Preradiation chemotherapy with vincristine, cisplatin, and cyclophosphamide is active in patients with advanced medulloblastoma but should be modified to minimize the risk of progressive disease while on therapy and to avoid delays in starting radiation therapy. Consistent use of the same neuroimaging modality is essential in documenting response.",
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T1 - Preradiation chemotherapy in advanced medulloblastoma

T2 - A Pediatric Oncology Group pilot study

AU - Mosijczuk, A. D.

AU - Nigro, M. A.

AU - Thomas, P. R M

AU - Burger, P. C.

AU - Krischer, J. P.

AU - Morantz, R. A.

AU - Kurdunowicz, B.

AU - Mulne, A. F.

AU - Towbin, R. B.

AU - Freeman, A. I.

AU - Nigro, E. D.

AU - Friedman, H. S.

AU - Kun, L. E.

PY - 1993

Y1 - 1993

N2 - Background. Children diagnosed with medulloblastoma whose tumor involves the brain stem or has spread through the cerebrospinal fluid pathways to other areas of the brain or spinal cord have a poor prognosis despite therapy with surgery, craniospinal irradiation (CSI), and chemotherapy. Preradiation chemotherapy may improve the outlook for these patients. Methods. To further study the role and feasibility of preradiation chemotherapy, children between the ages of 4 and 21 years diagnosed with advanced medulloblastoma and measurable disease were enrolled in the Pediatric Oncology Group 8695 study. Patients were treated with a 9-week course of vincristine, cisplatin, and cyclophosphamide followed by CSI. Imaging films were reviewed centrally for eligibility and response to chemotherapy. Toxicity to chemotherapy and radiation as well as delays and modifications in subsequent CSI were recorded. Results. Thirteen of 30 fully evaluable patients achieved complete or partial response (43%) to chemotherapy. Toxicity was mostly fever and neutropenia after cyclophosphamide, which is predictable and tolerable. Radiation therapy was delivered in full doses and volumes in most patients but was delayed in its start in most patients. Central review of films revealed frequent use of different imaging modalities at baseline and after therapy, making accurate assessment of tumor response difficult. Conclusion. Preradiation chemotherapy with vincristine, cisplatin, and cyclophosphamide is active in patients with advanced medulloblastoma but should be modified to minimize the risk of progressive disease while on therapy and to avoid delays in starting radiation therapy. Consistent use of the same neuroimaging modality is essential in documenting response.

AB - Background. Children diagnosed with medulloblastoma whose tumor involves the brain stem or has spread through the cerebrospinal fluid pathways to other areas of the brain or spinal cord have a poor prognosis despite therapy with surgery, craniospinal irradiation (CSI), and chemotherapy. Preradiation chemotherapy may improve the outlook for these patients. Methods. To further study the role and feasibility of preradiation chemotherapy, children between the ages of 4 and 21 years diagnosed with advanced medulloblastoma and measurable disease were enrolled in the Pediatric Oncology Group 8695 study. Patients were treated with a 9-week course of vincristine, cisplatin, and cyclophosphamide followed by CSI. Imaging films were reviewed centrally for eligibility and response to chemotherapy. Toxicity to chemotherapy and radiation as well as delays and modifications in subsequent CSI were recorded. Results. Thirteen of 30 fully evaluable patients achieved complete or partial response (43%) to chemotherapy. Toxicity was mostly fever and neutropenia after cyclophosphamide, which is predictable and tolerable. Radiation therapy was delivered in full doses and volumes in most patients but was delayed in its start in most patients. Central review of films revealed frequent use of different imaging modalities at baseline and after therapy, making accurate assessment of tumor response difficult. Conclusion. Preradiation chemotherapy with vincristine, cisplatin, and cyclophosphamide is active in patients with advanced medulloblastoma but should be modified to minimize the risk of progressive disease while on therapy and to avoid delays in starting radiation therapy. Consistent use of the same neuroimaging modality is essential in documenting response.

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