Outcome of children with high - risk Medulloblastoma treated with pre-irradiation chemotherapy

Abstract EN

Purpose : our aim was to determine whether : pre-irradiation chemotherapy is active and feasible in children with meduloblastoma.

Patients and methods : Twenty-one patients with high-risk medulloblastoma were given preirradiation chemotherapy as initial postoperative treatment at Radiation Oncology Unit from June 1997 through December 1999, patients were treated within 2 to 6 weeks after initial surgery with Cisplatin 100 mg / m2 I.V.

infusion over 6 hours day 1 with hydration and diuresis, Vincristine 1.5 mg / m2 I.V.

push days 1 and 8 (maximum 2 mg), Procarbazine 100 mg / m2 PO, days 1 to 14 and Prednisone 40 mg / m2 PO, days 1 to 14.

Cycles of chemotherapy were given 28 days apart.

In the absence of progressive disease, all patients received 3 cycles of chemotherapy, standard craniospinal irradiation followed by 3 cycles of the same chemotherapy regimen given before irradiation.

Results : among 21 assessable patients, Seventeen with (M0) disease, four had CR, seven had PR and six had SD.

Among four patients with (M1) disease at diagnosis, one had CR and three had PR after completion of three cycles of pre-irradiation chemotherapy.

After craniospinal irradiation, out of ten patients with PR to pre-irradiation chemotherapy, five achieved CR and out of six patients with SD, three achieved PR and the other three remain SD.

at the end of three cycles of post-radiation chemotherapy, there were fourteen patients with CR, five with PR and two with SD.

The 3-years PFS was 66.7±10%.

The median follow-up time for all survivors was 32 months (range, 20 to 44).

Myelosuppression was the predominant toxic effect with preirradiation chemotherapy.

Conclusion : our preliminary results of neoadjuvant chemotherapy in-patients with high-risk medulloblastoma are encouraging and this modality of treatment can be applied safely with acceptable toxicity.