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Randomized Controlled Trial
. 2013 Aug 10;31(23):2936-41.
doi: 10.1200/JCO.2012.43.9984. Epub 2013 Jul 15.

High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031)

Nancy J Tarbell  1 , Henry Friedman, William R Polkinghorn, Torunn Yock, Tianni Zhou, Zhengjia Chen, Peter Burger, Patrick Barnes, Larry Kun
Affiliations
Randomized Controlled Trial

High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031)

Nancy J Tarbell et al. J Clin Oncol. .

Abstract

Purpose: To compare event-free survival (EFS) in children with high-risk medulloblastoma randomly assigned to receive either chemotherapy before radiation or chemotherapy after radiation.

Patients and methods: One hundred twelve patients were randomly assigned to each arm. Criteria used to categorize patients as high risk included M1-4 disease by modified Chang staging classification, T3b/T4 disease, or greater than 1.5 cm3 of residual tumor after surgery. Postoperatively, children with high-risk medulloblastoma were randomly assigned to two arms, either chemotherapy entailing three cycles of cisplatin and etoposide before radiation (chemotherapy first [CT1]) or the same chemotherapy regimen after radiation (radiation therapy first [RT1]). Both groups received consolidation chemotherapy consisting of vincristine and cyclophosphamide.

Results: The median follow-up time was 6.4 years. Five-year EFS was 66.0% in the CT1 arm and 70.0% in the RT1 arm (P = .54), and 5-year overall survival in the two groups was 73.1% and 76.1%, respectively (P = .47). In the CT1 arm, 40 of the 62 patients with residual disease achieved either complete or partial remission.

Conclusion: Five-year EFS did not differ significantly whether, after surgery, patients received chemotherapy before or after radiotherapy.

Trial registration: ClinicalTrials.gov NCT00003573.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
CONSORT diagram. CT1, chemotherapy first; RT1, radiation therapy first. (*) Patients lost to follow-up or off study were censored at date last seen.
Fig 2.
Fig 2.
Pediatric Oncology Group 9031 study treatment schematic. VP-16, etoposide; XRT, radiation therapy.
Fig 3.
Fig 3.
Event-free survival by treatment arm for eligible patients.
See this image and copyright information in PMC

References

    1. Gurney JG, Davis S, Severson RK, et al. Trends in cancer incidence among children in the U.S. Cancer. 1996;78:532–541. - PubMed
    1. McNeil DE, Coté TR, Clegg L, et al. Incidence and trends in pediatric malignancies medulloblastoma/primitive neuroectodermal tumor: A SEER update—Surveillance Epidemiology and End Results. Med Pediatr Oncol. 2002;39:190–194. - PubMed
    1. Polkinghorn WR, Tarbell NJ. Medulloblastoma: Tumorigenesis, current clinical paradigm, and efforts to improve risk stratification. Nat Clin Pract Oncol. 2007;4:295–304. - PubMed
    1. Evans AE, Jenkin RD, Sposto R, et al. The treatment of medulloblastoma: Results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine, and prednisone. J Neurosurg. 1990;72:572–582. - PubMed
    1. Tait DM, Thornton-Jones H, Bloom HJ, et al. Adjuvant chemotherapy for medulloblastoma: The first multi-centre control trial of the International Society of Paediatric Oncology (SIOP I) Eur J Cancer. 1990;26:464–469. - PubMed

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