High-dose carboplatin, thiotepa, and etoposide with autologous stem cell rescue for patients with previously irradiated recurrent medulloblastoma Journal Article
| Authors: | Dunkel, I. J.; Gardner, S. L.; Garvin, J. H. Jr; Goldman, S.; Shi, W.; Finlay, J. L. |
| Article Title: | High-dose carboplatin, thiotepa, and etoposide with autologous stem cell rescue for patients with previously irradiated recurrent medulloblastoma |
| Abstract: | Recurrent medulloblastoma is highly lethal in previously irradiated patients. Previously irradiated patients with M-0-M-3 recurrences who achieved a minimal disease state prior to protocol enrollment received carboplatin (Calvert formula with area under the curve = 7 mg/ mL min, maximum 500 mg/m 2/day) on days -8 to -6, and thiotepa (300 mg/m2/day) and etoposide (250 mg/m2/day) on days -5 to -3, followed by autologous stem cell rescue (ASCR) on day 0. Twenty-five patients, aged 7.6-44.7 years (median 13.8 years) at ASCR, were treated. Three (12%) died of treatmentrelated toxicities within 30 days of ASCR, due to multiorgan system failure (n = 2) and aspergillus infection with veno-occlusive disease (n = 1). Tumor recurred in 16 at a median of 8.5 months (range 2.3-58.5 months). Six are event-free survivors at a median of 151.2 months post-ASCR (range 127.2-201.6 months). The Kaplan-Meier estimate of median overall survival is 26.8 months (95% CI: 11.9-51.1 months) and of event-free survival (EFS) and overall survival are both 24% (95% CI: 9.8%-41.7%) at 10 years post-ASCR. M-0 (vs M-1 + ) recurrence prior to protocol, lack of tissue confirmation of relapse, and initial therapy of radiation therapy (RT) alone (vs RT + chemotherapy) were not significantly associated with better EFS (P = .33, .34, and .27, respectively). Trends toward better EFS were noted in patients (n = 5) who received additional RT as part of their retrieval therapy (P = .07) and whose recurrent disease was demonstrated to be sensitive to reinduction chemotherapy (P = .09). This retrieval strategy provides longterm EFS for some patients with previously irradiated recurrent medulloblastoma. The use of additional RT may be associated with better outcome. © The Author(s) 2010. |
| Keywords: | adolescent; adult; cancer chemotherapy; child; clinical article; controlled study; event free survival; preschool child; school child; child, preschool; disease-free survival; young adult; clinical trial; mortality; salvage therapy; multimodality cancer therapy; cancer radiotherapy; disease free survival; combined modality therapy; chemotherapy; methodology; antineoplastic agent; carboplatin; quality of life; neoplasm recurrence, local; etoposide; mucosa inflammation; antineoplastic combined chemotherapy protocols; radiotherapy; autologous stem cell transplantation; hematopoietic stem cell transplantation; thiotepa; kaplan-meiers estimate; tumor recurrence; medulloblastoma; pancytopenia; kaplan meier method; cerebellar neoplasms; aspergillosis; multiple organ failure; cerebellum tumor |
| Journal Title: | Neuro-Oncology |
| Volume: | 12 |
| Issue: | 3 |
| ISSN: | 1522-8517 |
| Publisher: | Oxford University Press |
| Date Published: | 2010-03-01 |
| Start Page: | 297 |
| End Page: | 303 |
| Language: | English |
| DOI: | 10.1093/neuonc/nop031 |
| PUBMED: | 20167818 |
| PROVIDER: | scopus |
| PMCID: | PMC2940591 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: NEURJ" - "Source: Scopus" |
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