Chemotherapy Dose-intensity and Survival for Childhood Medulloblastoma

• Published in: Anticancer research 2012-09, Vol.32 (9), p.3885-3892
• Main Authors: SMITH, R. L, SHI, X, ESTLIN, E. J
• Format: Article
• Language: English
• Subjects: Adolescent; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Cerebellar Neoplasms - drug therapy; Cerebellar Neoplasms - mortality; Cerebellar Neoplasms - radiotherapy; Chemotherapy; Child; Child, Preschool; Children; Cisplatin; Cisplatin - administration & dosage; Clinical trials; Clinical Trials, Phase III as Topic; Cyclophosphamide; Cyclophosphamide - administration & dosage; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Female; Humans; Infant; Infant, Newborn; Lomustine - administration & dosage; Male; Medical sciences; Medulloblastoma; Medulloblastoma - drug therapy; Medulloblastoma - mortality; Medulloblastoma - radiotherapy; Neurology; Radiotherapy; Risk factors; Risk groups; Survival; Tumors; Tumors of the nervous system. Phacomatoses; Vincristine; Vincristine - administration & dosage
• ISSN: 0250-7005; 1791-7530

To determine the relationship between prescribed dose-intensity of chemotherapy and survival in childhood medulloblastoma. A total of 55 trials from 1970-2009 were identified, 30 were eligible for analysis, with individual treatment regimes with 5-year (or more) outcome figures. Relationships of outcome to dose-intensity were analysed using weighted regression. Overall, 2,434 patients were identified, 1,010 were classified as 'standard'- and 671 as 'high'-risk patients, with 5-year overall survivals (OS) of 67.2% (95% Confidence Interval=60.5%-73.6%) and 47.6% (95% Confidence Interval=39.5%-55.7%), respectively. A protective effect for chemotherapy versus craniospinal radiotherapy alone (5-year OS of 58.2% versus 51.6%) was found. Individually, vincristine, cisplatin, lomustine (CCNU) and cyclophosphamide appear to confer the most beneficial effect, particularly for high-risk patients. Positive relationships between OS and dose-intensity were found, except for lomustine, with cyclophosphamide offering the greatest protection. Consideration of chemotherapy dose-intensity may further optimise treatment, particularly in the context of risk stratification.