The UK Experience of a Treatment Strategy for Pediatric Metastatic Medulloblastoma Comprising Intensive Induction Chemotherapy, Hyperfractionated Accelerated Radiotherapy and Response Directed High Dose Myeloablative Chemotherapy or Maintenance Chemotherapy (Milan Strategy).

Autor: Vivekanandan S; Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK., Breene R; Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK., Ramanujachar R; Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Traunecker H; Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK., Pizer B; Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK., Gaze MN; Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK., Saran F; Clinical Oncology, The Royal Marsden NHS Foundation Trust, Surrey, UK., Thorp N; Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK., English M; Paediatric Oncology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK., Wheeler KA; Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Michalski A; Paediatric Oncology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK., Walker DA; Paediatric Oncology, Nottingham Children's Hospital University of Nottingham, Nottingham, UK., Saunders D; Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK., Cowie F; Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK., Cameron A; Clinical Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK., Picton SV; Paediatric Oncology, The Leeds Teaching Hospitals, Leeds, UK., Parashar D; Cancer Research Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., Horan G; Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK., Williams MV; Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital, Cambridge, UK.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2015 Dec; Vol. 62 (12), pp. 2132-9. Date of Electronic Publication: 2015 Aug 14.
DOI: 10.1002/pbc.25663
Abstrakt: Background: Historically, the 5-year overall survival (OS) for metastatic medulloblastoma (MMB) was less than 40%. The strategy of post-operative induction chemotherapy (IC) followed by hyperfractionated accelerated radiotherapy (HART) and response directed high dose chemotherapy (HDC) was reported in a single center study to improve 5-year OS to 73%. We report outcomes of this strategy in UK.
Methods: Questionnaires were sent to all 20 UK pediatric oncology primary treatment centers to collect retrospective data on delivered treatment, toxicity and survival with this strategy in children aged 3-19 years with MMB.
Results: Between February 2009 and October 2011, 34 patients fulfilled the entry criteria of the original study. The median age was 7 years (range 3-15). Median interval from surgery to HART was 109 versus 85 days in the original series. The incidence of grade 3 or 4 hematological toxicities with IC and HDC was 83-100%. All 16 patients who achieved complete response by the end of the regimen remain in remission but only three of 18 patients with lesser responses are still alive (P < 0.0001). With a median follow-up of 45 months for survivors, the estimated 3-year OS is 56% (95% CI 38, 71). This result is outside the 95% CI of the original study results and encompasses the historical survival result of 40%.
Conclusion: Within the limits of statistical significance, we did not replicate the improved survival results reported in the original series. The reasons include differences in patient sub-groups and protocol administration. International randomized phase III studies are needed.
(© 2015 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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