Adjuvant chemotherapy in the treatment of localized medulloblastoma in children

Purpose. Medulloblastoma (MB) is the most common malignant brain tumor of the posterior fossa (PF) in children. Historically, treatment has consisted of surgical excision followed by neuraxis radiation and has resulted in 60-65% long-term disease-free survival in standard-risk disease. In an effort to improve clinical outcome, we conducted a pilot study that incorporated adjuvant chemotherapy into the initial therapeutic regimen for children with standard-risk medulloblastoma. Patients and Methods. Between May, 1992 and January, 1997 twelve children who presented consecutively with standard-risk PF MB were treated with surgery, followed by standard dose total neuraxis irradiation, and multi-agent chemotherapy. Chemotherapy consisted of six cycles of vincristine, methylprednisolone, cisplatin and cyclophosphamide. Results. At a median duration of 55 months (mean duration 66 months) from diagnosis, all patients remain alive without evidence of disease. Hematologic toxicity predominated with Grade IV neutropenia and thrombocytopenia following 54% and 4%, respectively, of administered cycles of chemotherapy. Conclusions. While longer follow up is necessary, this regimen shows promise for improved clinical outcome in children with standard-risk PF MB. This regimen was well tolerated, with the major toxicity being hematologic.