Medulloblastoma
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Wayne H. Liang, MD, MS, FAMIA UAB Birmingham, AL  WayneLiangMD
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Adjuvant therapy
Carboplatin, Cyclophosphamide, Etoposide, Methotrexate, Vincristine
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Regimen
| Study | Evidence |
|---|---|
| Rutkowski et al. 2005 | Non-randomized |
Preceding treatment
Chemotherapy
- Carboplatin (Paraplatin)
- Cyclophosphamide (Cytoxan)
- Etoposide (Vepesid)
- Methotrexate (MTX)
- Vincristine (Oncovin)
References
- Rutkowski S, Bode U, Deinlein F, Ottensmeier H, Warmuth-Metz M, Soerensen N, Graf N, Emser A, Pietsch T, Wolff JE, Kortmann RD, Kuehl J. Treatment of early childhood medulloblastoma by postoperative chemotherapy alone. N Engl J Med. 2005 Mar 10;352(10):978-86. link to original article PubMed
Cisplatin, Lomustine, Vincristine
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Regimen
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Packer et al. 2006 | 1996-2000 | Phase III (C) | Cisplatin, Cyclophosphamide, Vincristine | Did not meet primary endpoint of EFS |
Preceding treatment
- Surgery, then radiotherapy
Chemotherapy
References
- Packer RJ, Gajjar A, Vezina G, Rorke-Adams L, Burger PC, Robertson PL, Bayer L, LaFond D, Donahue BR, Marymont MH, Muraszko K, Langston J, Sposto R. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol. 2006 Sep 1;24(25):4202-8. link to original article PubMed
Cyclophosphamide & Vincristine/Cisplatin & Etoposide
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Protocol
| Study | Evidence |
|---|---|
| Duffner et al. 1993 | Non-randomized |
Total duration of treatment is 12 to 24 months.
Preceding treatment
- Surgical resection or biopsy
Chemotherapy, part 1
28-day cycle for 2 cycles, alternating with part 2
Chemotherapy, part 2
28-day cycle for 1 cycle, alternating with part 1
References
- Duffner PK, Horowitz ME, Krischer JP, Friedman HS, Burger PC, Cohen ME, Sanford RA, Mulhern RK, James HE, Freeman CR, Seidel FG, Kun LE. Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. N Engl J Med. 1993 Jun 17;328(24):1725-31. link to original article PubMed
VCP
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VCP: Vincristine, CCNU (Lomustine), Prednisone
Regimen
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Zeltzer et al. 1999 (CCG-921) | 1986-1992 | Phase III (C) | 8-in-1 | Superior PFS |
Preceding treatment
- Surgery, then Vincristine & RT
Chemotherapy
- Vincristine (Oncovin) 1.5 mg/m2 IV once per day on days 1, 8, 15
- Lomustine (CCNU) 100 mg/m2 IV once on day 1
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
6-week cycle for 8 cycles
References
- CCG-921: Zeltzer PM, Boyett JM, Finlay JL, Albright AL, Rorke LB, Milstein JM, Allen JC, Stevens KR, Stanley P, Li H, Wisoff JH, Geyer JR, McGuire-Cullen P, Stehbens JA, Shurin SB, Packer RJ. Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children's Cancer Group 921 randomized phase III study. J Clin Oncol. 1999 Mar;17(3):832-45. link to original article contains verified protocol PubMed