High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031).

Journal Article (Journal Article;Multicenter Study)

PURPOSE: To compare event-free survival (EFS) in children with high-risk medulloblastoma randomly assigned to receive either chemotherapy before radiation or chemotherapy after radiation. PATIENTS AND METHODS: One hundred twelve patients were randomly assigned to each arm. Criteria used to categorize patients as high risk included M1-4 disease by modified Chang staging classification, T3b/T4 disease, or greater than 1.5 cm3 of residual tumor after surgery. Postoperatively, children with high-risk medulloblastoma were randomly assigned to two arms, either chemotherapy entailing three cycles of cisplatin and etoposide before radiation (chemotherapy first [CT1]) or the same chemotherapy regimen after radiation (radiation therapy first [RT1]). Both groups received consolidation chemotherapy consisting of vincristine and cyclophosphamide. RESULTS: The median follow-up time was 6.4 years. Five-year EFS was 66.0% in the CT1 arm and 70.0% in the RT1 arm (P = .54), and 5-year overall survival in the two groups was 73.1% and 76.1%, respectively (P = .47). In the CT1 arm, 40 of the 62 patients with residual disease achieved either complete or partial remission. CONCLUSION: Five-year EFS did not differ significantly whether, after surgery, patients received chemotherapy before or after radiotherapy.

Full Text

Duke Authors

Cited Authors

  • Tarbell, NJ; Friedman, H; Polkinghorn, WR; Yock, T; Zhou, T; Chen, Z; Burger, P; Barnes, P; Kun, L

Published Date

  • August 10, 2013

Published In

Volume / Issue

  • 31 / 23

Start / End Page

  • 2936 - 2941

PubMed ID

  • 23857975

Pubmed Central ID

  • PMC3732312

Electronic International Standard Serial Number (EISSN)

  • 1527-7755

Digital Object Identifier (DOI)

  • 10.1200/JCO.2012.43.9984


  • eng

Conference Location

  • United States