Treatment > Cisplatin · Etoposide · Ifosfamide  

Meeting Abstract

Low-dose craniospinal irradiation and ifosfamide, cisplatine, and etoposide for embryonal tumors in central nervous system

H. Shirato, J. Ikeda, H. Aoyama, N. Ishii, T. Taguchi, T. Kato, M. Tada, Y. Sawamura

for the Hokkaido Neurosurgery Group; Hokkaido University, School of Medicine, Sapporo, Japan

The standard therapy for embryonal tumors has been 36 Gy craniospinal irradiation (CSI) and 54-55.8 Gy to the tumor bed. 
To reduce the incidence of late adverse effects of CSI, a phase II study has been carried out to evaluate the effects of chemotherapy combined with low-dose CSI. 
For patients older than 2.5 years, surgery was followed by one course of chemotherapy, which in turn was followed by radiotherapy and then 7 cycles of chemotherapy. 
For patients younger than that, surgery was followed by 8 cycles of chemotherapy and then radiotherapy. 
Chemotherapy consisted of ifosfamide (900 mg/m2, day 1-5), cisplatin (20 mg/m2, days 1-5), and etoposide (60 mg/m2, days 1-5), and was given every 4 weeks. 
Patients without dissemnation younger than 3 years received 18 Gy in 9-10 fractions (18 Gy/9-10f), and those 3 years old or older received 24 Gy/12f. 
Patients with dissemination received 30 Gy/15f. 
The dose to the primary tumor bed was 54 Gy/27-30f for patients over 3 years old, and 50.4 Gy/25-28f for youngers. 
From 1990 to 2000, 23 patients aged 0.5 to 26 (median 6) were enrolled. 
Seventeen medulloblastoma (MB) and 6 supratentorial primitive neuroectodermal tumors (ST-PNET) were included. 
Total or nearly total resection was performed in 18 and partial resection in 5. 
The mean follow-up period was 46 months (5 to 117). 
The 5-year actuarial overall survival rate was 
78% for the average risk group (3 years or older, total resection, posterior fossa, and no dissemination) and 
57% for the poor-risk group(others) (p=0.25); 
71% for the patients in the poor-risk group without dissemination and 
0% for those with dissemination (p=0035); 
62% for MB, and 
67% for SP-PNET (p=0.44). 
At 2-8 years (median 7) after treatment, the median full-scale intellectual quotient (IQ) for MB patients was 78; for the ST-PNET patients, it was 63. 
There was no significant decline of IQ during the follow-up period. 
In conclusion, the combination of chemotherapy and low-dose CSI was suggested to achieve survival rates equivalent to standard dose radiotherapy, but with the possibility of reducing the risk of late neuro-cognitive damage.

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