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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2023.865    [Accepted]
Long-term Outcomes of Protocol-based Treatment for Newly Diagnosed Medulloblastoma
Won Kee Ahn1,2 , Seung Min Hahn1,2, Hong In Yoon3, Jeongshim Lee4, Eun Kyung Park5, Kyu Won Shim5, Dong Seok Kim5, Chang-Ok Suh6, Se Hoon Kim7, Chuhl Joo Lyu1,2, Jung Woo Han1,2
1Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
2Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
3Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
4Department of Radiation Oncology, Inha University Hospital, Incheon, Korea
5Department of Neurosurgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
6Department of Radiation Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
7Department of Pathology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
Correspondence  Jung Woo Han ,Tel: 82-2-2228-2050, Fax: 82-2-393-9118, Email: jwhan@yuhs.ac
Received: July 23, 2023;  Accepted: November 29, 2023.  Published online: November 30, 2023.
ABSTRACT
Purpose
The Korean Society of Pediatric Neuro-Oncology (KSPNO) conducted treatment strategies for children with medulloblastoma (MB) by using alkylating agents for maintenance chemotherapy or tandem high-dose chemotherapy (HDC) with autologous stem cell rescue (ASCR) according to the risk stratification. The purpose of the study was to assess treatment outcomes and complications based on risk-adapted treatment and HDC.
Materials and Methods
Fifty-nine patients diagnosed with MB were enrolled in this study. Patients in the standard-risk (SR) group received radiotherapy (RT) after surgery and chemotherapy using the KSPNO M051 regimen. Patients in the high-risk (HR) group received two and four chemotherapy cycles according to the KSPNO S081 protocol before and after reduced RT for age following surgery and two cycles of tandem HDC with ASCR consolidation treatment.
Results
In the SR group, 24 patients showed 5-year event-free survival (EFS) and overall survival (OS) estimates of 86.7% (95% confidence interval [CI], 73.6–100%) and 95.8% (95%CI, 88.2–100%), respectively. In the HR group, more infectious complications and mortality occurred during the second HDC than during the first. In the HR group, the 5-year EFS and OS estimates were 65.5% (95%CI, 51.4–83.4) and 72.3% (95%CI, 58.4–89.6), respectively.
Conclusion
High intensity of alkylating agents for SR resulted in similar outcomes but with a high incidence of hematologic toxicity. Tandem HDC with ASCR for HR induced favorable EFS and OS estimates compared to those reported previously. However, infectious complications and treatment-related mortalities suggest that a reduced chemotherapy dose is necessary, especially for the second HDC.
Key words: Medulloblastoma, High-dose chemotherapy, Autologous stem cell rescue, Children
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