(ChemotherapyAdvisor) – Very young children with nonmetastatic medulloblastoma have increased event-free survival (EFS) when conformal radiation therapy (CRT) is added to postoperative chemotherapy vs chemotherapy alone, according to results of the prospective Children’s Oncology Group Study P9934 published in the Journal of Clinical Oncology online July 30, 2012.

Following initial surgery, 74 children between 8 months and 3 years of age received 4 cycles of induction chemotherapy followed by age- and response-adjusted CRT to the posterior fossa and tumor bed and maintenance chemotherapy. The investigators evaluated neurodevelopmental outcomes and EFS results were compared with a previous study of multiagent chemotherapy without irradiation, the Pediatric Oncology Group (POG) trial 9233,” noted David M. Ashley, MBBS, FRACP, PhD, of The Andrew Love Cancer Centre, Geelong, Victoria, Australia, and colleagues.

Results compared favorably to those of POG 9233; 4-year EFS was 50% and overall survival, 69%. “Analysis showed that the desmoplastic/nodular subtype was a favorable factor in predicting survival,” they wrote, with the 4-year EFS rate being 58% for children with desmoplasia.

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A total of 7 of 10 patients with disease progression before CRT had primary-site failure; 15 of 19 who progressed after CRT had distant-site failure. “Neurodevelopmental assessments did not show a decline in cognitive or motor function after protocol-directed chemotherapy and CRT,” they concluded. “Future studies will use histopathologic typing (desmoplastic/nodular versus nondesmoplastic/nodular) to stratify patients for therapy by risk of relapse.”