FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 352:978-986 March 10, 2005 Number 10 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by DeAngelis, L. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The prognosis for young children with medulloblastoma is poor, and survivors are at high risk for cognitive deficits. We conducted a trial of the treatment of this brain tumor by intensive postoperative chemotherapy alone.

Methods After surgery, children received three cycles of intravenous chemotherapy (cyclophosphamide, vincristine, methotrexate, carboplatin, and etoposide) and intraventricular methotrexate. Treatment was terminated if a complete remission was achieved. Leukoencephalopathy and cognitive deficits were evaluated.

Results Forty-three children were treated according to protocol. In children who had complete resection (17 patients), residual tumor (14), and macroscopic metastases (12), the five-year progression-free and overall survival rates (±SE) were 82±9 percent and 93±6 percent, 50±13 percent and 56±14 percent, and 33±14 percent and 38±15 percent, respectively. The rates in 31 patients without macroscopic metastases were 68±8 percent and 77±8 percent. Desmoplastic histology, metastatic disease, and an age younger than two years were independent prognostic factors for tumor relapse and survival. Treatment strategies at relapse were successful in 8 of 16 patients. There were no major instances of unexpected toxicity. In 19 of 23 children, asymptomatic leukoencephalopathy was detected by magnetic resonance imaging. After treatment, the mean IQ was significantly lower than that of healthy controls within the same age group but higher than that of patients in a previous trial who had received radiotherapy.

Conclusions Postoperative chemotherapy alone is a promising treatment for medulloblastoma in young children without metastases.

Source Information

From the Department of Pediatric Oncology, Children's Hospital (S.R., F.D., H.O., J.K.), and the Departments of Neuroradiology (M.W.-M.) and Pediatric Neurosurgery (N.S.), University of Würzburg, Würzburg; the Department of Pediatric Oncology, Children's Hospital (U.B.) and National Reference Center for Brain Tumors, Department of Neuropathology (T.P.), University of Bonn, Bonn; the Department of Pediatric Oncology, Children's Hospital, University of Homburg/Saar, Homburg/Saar (N.G.); Institute for Medical Statistics, Epidemiology, and Informatics, University of Mainz, Mainz (A.E.); the Department of Pediatric Oncology, Children's Hospital, University of Regensburg, Regensburg (J.E.A.W.); and the Department of Radiotherapy, University of Leipzig, Leipzig (R.D.K.) — all in Germany.

Dr. Kuehl is deceased.

Address reprint requests to Dr. Rutkowski at the Department of Pediatric Oncology, Children's Hospital, University of Würzburg, Josef-Schneider-Str. 2, D-97080 Würzburg, Germany, or at rutkowski{at}mail.uni-wuerzburg.de.

Full Text of this Article

Related Letters:

Treatment of Brain Tumors
Paulino A. C., Teh B. S., Sadeh M., Seiter K., Ashby L., LaRocca R., Ryken T., Aiken R. D., Rutkowski S., Ottensmeier H., Pietsch T., Stupp R., Hegi M. E., DeAngelis L. M.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:2350-2353, Jun 2, 2005. Correspondence

This article has been cited by other articles:

• Pizer, B, Clifford, S (2008). Medulloblastoma: new insights into biology and treatment. EDUCATION AND PRACTICE 93: 137-144 [Full Text]  
• de Haas, T., Hasselt, N., Troost, D., Caron, H., Popovic, M., Zadravec-Zaletel, L., Grajkowska, W., Perek, M., Osterheld, M.-C., Ellison, D., Baas, F., Versteeg, R., Kool, M. (2008). Molecular Risk Stratification of Medulloblastoma Patients Based on Immunohistochemical Analysis of MYC, LDHB, and CCNB1 Expression. Clin. Cancer Res. 14: 4154-4160 [Abstract] [Full Text]  
• Gerber, N U, Zehnder, D, Zuzak, T J, Poretti, A, Boltshauser, E, Grotzer, M A (2008). Outcome in children with brain tumours diagnosed in the first year of life: long-term complications and quality of life. Arch. Dis. Child. 93: 582-589 [Abstract] [Full Text]  
• Rossi, A., Caracciolo, V., Russo, G., Reiss, K., Giordano, A. (2008). Medulloblastoma: From Molecular Pathology to Therapy. Clin. Cancer Res. 14: 971-976 [Abstract] [Full Text]  
• Mabbott, D. J., Barnes, M., Laperriere, N., Landry, S. H., Bouffet, E. (2007). Neurocognitive function in same-sex twins following focal radiation for medulloblastoma. Neuro Oncol 9: 460-464 [Abstract] [Full Text]  
• Bull, K. S., Spoudeas, H. A., Yadegarfar, G., Kennedy, C. R. (2007). Reduction of Health Status 7 Years After Addition of Chemotherapy to Craniospinal Irradiation for Medulloblastoma: A Follow-Up Study in PNET 3 Trial Survivors on Behalf of the CCLG (formerly UKCCSG). JCO 25: 4239-4245 [Abstract] [Full Text]  
• Raffaghello, L., Nozza, P., Morandi, F., Camoriano, M., Wang, X., Garre, M. L., Cama, A., Basso, G., Ferrone, S., Gambini, C., Pistoia, V. (2007). Expression and Functional Analysis of Human Leukocyte Antigen Class I Antigen-Processing Machinery in Medulloblastoma. Cancer Res. 67: 5471-5478 [Abstract] [Full Text]  
• Rutkowski, S., von Bueren, A., von Hoff, K., Hartmann, W., Shalaby, T., Deinlein, F., Warmuth-Metz, M., Soerensen, N., Emser, A., Bode, U., Mittler, U., Urban, C., Benesch, M., Kortmann, R. D., Schlegel, P. G., Kuehl, J., Pietsch, T., Grotzer, M. (2007). Prognostic Relevance of Clinical and Biological Risk Factors in Childhood Medulloblastoma: Results of Patients Treated in the Prospective Multicenter Trial HIT'91. Clin. Cancer Res. 13: 2651-2657 [Abstract] [Full Text]  
• Timmermann, B., Kortmann, R.-D., Rutkowski, S. (2006). In Reply. JCO 24: 5609-5610 [Full Text]  
• Timmermann, B., Kortmann, R.-D., Kuhl, J., Rutkowski, S., Meisner, C., Pietsch, T., Deinlein, F., Urban, C., Warmuth-Metz, M., Bamberg, M. (2006). Role of Radiotherapy in Supratentorial Primitive Neuroectodermal Tumor in Young Children: Results of the German HIT-SKK87 and HIT-SKK92 Trials. JCO 24: 1554-1560 [Abstract] [Full Text]  
• Meyers, C. A., Brown, P. D. (2006). Role and Relevance of Neurocognitive Assessment in Clinical Trials of Patients With CNS Tumors. JCO 24: 1305-1309 [Abstract] [Full Text]  
• Stearns, D., Chaudhry, A., Abel, T. W., Burger, P. C., Dang, C. V., Eberhart, C. G. (2006). c-Myc Overexpression Causes Anaplasia in Medulloblastoma. Cancer Res. 66: 673-681 [Abstract] [Full Text]  
• Herbst, R. S., Bajorin, D. F., Bleiberg, H., Blum, D., Hao, D., Johnson, B. E., Ozols, R. F., Demetri, G. D., Ganz, P. A., Kris, M. G., Levin, B., Markman, M., Raghavan, D., Reaman, G. H., Sawaya, R., Schuchter, L. M., Sweetenham, J. W., Vahdat, L. T., Vokes, E. E., Winn, R. J., Mayer, R. J. (2006). Clinical Cancer Advances 2005: Major Research Advances in Cancer Treatment, Prevention, and Screening--A Report From the American Society of Clinical Oncology. JCO 24: 190-205 [Abstract] [Full Text]  
• Paulino, A. C., Teh, B. S., Sadeh, M., Seiter, K., Ashby, L., LaRocca, R., Ryken, T., Aiken, R. D., Rutkowski, S., Ottensmeier, H., Pietsch, T., Stupp, R., Hegi, M. E., DeAngelis, L. M. (2005). Treatment of brain tumors.. NEJM 352: 2350-2353 [Full Text]  
• (2005). For Childhood Medulloblastoma, Using Only Chemotherapy May Spare Cognition. JWatch Neurology 2005: 6-6 [Full Text]  
• DeAngelis, L. M. (2005). Chemotherapy for Brain Tumors -- A New Beginning. NEJM 352: 1036-1038 [Full Text]