High-Risk Medulloblastoma : A Pediatric Oncology Group Randomized Trial of Chemotherapy Before or After Radiation Therapy (POG 9031)
Mené sur 112 patients pédiatriques atteints d'un médulloblastome à risque élevé de récidive et traités par chirurgie (durée médiane de suivi : 6,4 ans), cet essai randomisé évalue, du point de vue de la survie sans événement et de la survie globale à 5 ans, l'efficacité d'une chimiothérapie par cisplatine-étoposide avant ou après une radiothérapie
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.